Intimate examinations and non-English speakers

A recent case at MDDUS has highlighted the risks involving intimate examinations when the patient is a non-English speaker.

Dr J, a hospital ST, was on call when a young Polish woman attended A&E complaining of abdominal pain. Dr J screened off a trolley and with the presence of a chaperone palpated the patient's abdomen. The woman had only limited English and Dr J had tried his best to ensure she understood the nature of the examination. Later the patient made a complaint she had been "painfully groped". Dr J was suspended by the employing Trust as a prelude to possible disciplinary proceedings and was also reported to the police.

A matter of perception

Intimate examinations in general include those of the breasts, genitalia or rectum but to some patients may involve simply touching them or even being close.

It is essential to obtain consent before carrying out an intimate examination and to record that consent. This consent must be informed, in that the patient understands the reason why the examination is being carried out and also how it will be conducted. What part of the body will be examined? Will there be any discomfort?

Clearly, if the patient has little or no comprehension of English then it will be difficult to ensure that the nature of the examination has been fully understood and consent granted on that basis. A chaperone may be able to confirm that an examination has been conducted in a professional and appropriate manner but cannot ensure that it was consensual.

To avoid any misunderstanding a trained medical interpreter is desirable when dealing with non-English-speaking patients in order to avoid potential complaints or medico-legal claims. It is preferable to have the interpreter present during physical examinations if the patient is agreeable. Otherwise extra care must be taken to explain beforehand and via the interpreter exactly what will happen during the examination.

Outcome

In the end DR J was interviewed by the police under caution. The chaperone who witnessed the examination was contacted (with some difficulty as her contact details had not been recorded) in order to corroborate Dr J's version of events. He has since been reinstated.

ACTION: ensure that non-English speaking patients requiring an intimate examination provide informed consent; this is best accomplished via the services of a trained interpreter. Ensure also the patient is given the option of a chaperone (even when the clinician is the same gender as the patient). Record all discussions regarding consent in the notes - and don't forget to include the name and contact details of the chaperone.

For more full GMC guidance on intimate examinations see: Maintaining a professional boundary between you and your patient (2013)