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doctors to take and record the patient’s consent. When undressing, the patient should be given privacy and during the examination you should try to keep them covered as much as possible to maintain their dignity. It is not appropriate to help the patient undress unless they have specifically asked for your assistance.


During the examination it is important to


keep explaining what you are doing and ask permission from the patient if this differs from what was originally agreed. It is okay to chat to the patient to make them feel at ease but keep the conversation relevant and avoid making any unnecessary comments which may be open to misinterpretation. You should also be prepared to stop the examination if the patient asks you to.


Chaperones Before carrying out an intimate examination, it is important to ask the patient if they would like an impartial observer to act as a chaperone during the consultation. This applies whether or not you are the same gender as the patient. The chaperone does not have to be medically qualified but should be sensitive and respectful of the patient’s dignity and confidentiality. He or she should be prepared to reassure the patient if they show signs of distress or discomfort and be familiar with the procedures involved in a routine intimate examination. The chaperone must also be prepared to raise concerns about a doctor’s behaviour where necessary. In some


circumstances a member of practice staff or a relative or friend of the patient may be an acceptable chaperone. It is important that any discussion about a


chaperone is noted in the medical record, including the chaperone’s name. If the patient does not want a chaperone and you are happy


Importantly, the doctor also failed to check the patient understood what she had been told. It was also extremely remiss for the doctor not to offer the patient a chaperone. It is not uncommon for GPs to consult with


“ BE PREPARED TO STOP THE EXAMINATION IF THE PATIENT ASKS YOU TO”


to proceed, then it should be noted that a chaperone was offered and declined. If either the doctor or patient does not wish the examination to proceed without a chaperone or either party is uncomfortable with the choice of chaperone, you can offer to delay the examination until a suitable chaperone is available. Any decision that is made should take into account the patient’s best interests.


A failure to communicate Let’s return to the scenario. It is easy now to see that the consent taken in this case was not informed. The doctor failed to adequately explain what she intended to do and instead relied on the assumption that the patient, having previously had a smear test, would understand what she was talking about.


patients who speak little or no English. In these cases, it is the doctor’s duty to ensure arrangements are made to meet the patient’s language and communication needs. An interpreter can usually be arranged in advance through your health board or PCT. In the scenario, the fact this


patient is Polish should have prompted the doctor to be especially vigilant in checking her understanding. Beware the patient


who smiles and nods but actually has very little understanding of what is being said. Check frequently that patients do understand fully what you are saying and, if in doubt, offer to organise an interpreter or ask them to return with an appropriate person who can assist at the review appointment. This is especially important when it comes to intimate examinations where the potential for misunderstanding is great and can lead to very serious consequences for the doctor. Hopefully after reading this article you will


not make the same mistakes, but please do not hesitate to contact MDDUS for advice if you are ever in any doubt.


Dr Susan Gibson-Smith is a medical adviser at MDDUS


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