12 • Advice
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Intimate examinations can be a distressing experience. MDDUS medical adviser Dr Susan Gibson-Smith offers some advice on how best to approach these sensitive situations
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OCTORS are routinely required to examine the most intimate areas of a patient’s body and it is something that can quickly become routine. But while it may be an everyday common occurrence for GPs, this
kind of medical attention can often be embarrassing or distressing for patients. And unless doctors are careful to fully explain how an intimate examination will be conducted and gain informed consent, there is a risk they could find themselves the subject of a patient complaint.
Consider the following scenario: It was a routine consultation for a repeat prescription for the contraceptive pill. The computer screen flagged up that this Polish lady was due a smear test so, to save time, I decided to take the smear sample myself rather than have her come back. I advised her she was due a smear test and asked if she would mind if I did it during the consultation. She nodded and lay down on the examination couch. Her record indicated she had had a smear before so I didn’t foresee any problems. I took the smear without difficulty but it was only afterwards that I noticed something was
wrong. Her eyes filled with tears as she told me she hadn’t realised what I had asked her, that she had not wanted this examination and would be writing a letter of complaint about me to the practice manager. I was shaken by this, after all I was only trying to help her and stop her having to come back. I had her best interests at heart, so surely I had done nothing wrong?
Consent The principle that “every person has the right to have his bodily integrity protected against invasion by others” has long been recognised in common law and has been defined in case law in many jurisdictions, perhaps most classically by Justice Benjamin Cardozo in his 1914 ruling in New York: “Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without the patient’s consent commits an assault.” When considered in these terms, it is clear
why the process of securing informed consent is so vitally important in medicine, not only for the patient’s benefit but also to protect the
doctor from any accusations of wrong-doing. For consent to be valid it must be informed,
competent and freely given. It must then be recorded, clearly and contemporaneously, in the medical notes. The General Medical Council provide more detailed information in their core guidance Good Medical Practice (paragraph 36) and in supplementary guidance Seeking patients’ consent: The ethical considerations. Failure to follow this guidance, particularly in intimate examinations, could put your registration at risk so it is essential you familiarise yourself with it.
Intimate examination So what constitutes an intimate examination? Most people would agree this is likely to include examination of the breasts, genitalia and rectum, but definitions can vary from patient to patient. In some cases, a patient may perceive an intimate examination as one where the doctor touches them or even moves close to them. A patient’s culture or belief system can influence their views of intimate examinations and it is worth reading the GMC guidance Personal Beliefs and Medical Practice for more information. Another GMC guidance document that is
useful when considering intimate examinations is Maintaining Boundaries. This emphasises the doctor’s duty to explain why the examination is required in a way the patient can understand and to allow them to ask questions before beginning the examination. It also stresses the need for
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