Ensure adequate chaperoning to prevent sex assault claims

ONE of the worst complaints a doctor can receive is that they inappropriately touched or examined a patient. Worse still would be an allegation of sexual assault from a patient. But these types of complaints are not that uncommon, as recent calls to the MDDUS advice line have highlighted.

Intimate examinations are a necessary, if not embarrassing or distressing, part of medical care for some patients. If examinations of this nature are not approached in the right way a patient may complain – and this can have a major impact on a doctor’s career. It is not unusual for patients to report such concerns directly to the General Medical Council or even the police.

There are a number of measures doctors can take to help avoid such accusations. It is crucial to always follow GMC guidance Maintaining boundaries – guidance for doctors when carrying out intimate examinations. One key element of this is to offer a chaperone wherever possible, even when doctor and patient are of the same gender.

While a chaperone does not have to be medically qualified, they must be familiar with normal examination techniques and good conduct. They should be sensitive and respectful of the patient’s dignity and confidentiality and be prepared to reassure the patient if they show signs of distress or discomfort. A chaperone should also be prepared to raise concerns about a doctor if misconduct occurs. In some circumstances, a member of practice staff, or a relative or friend may be an acceptable chaperone.

Should no chaperone be available and the doctor or patient are unwilling to proceed without one, the patient should be given the option of delaying the examination to a later date. The name of the chaperone should always be recorded and it should also be noted if a patient refuses a chaperone.

The GMC guidance also highlights the need for doctors to give careful consideration to what a patient may perceive as an intimate examination. This will generally include the breast, genitalia and rectum but for some patients may include the chest, groin or abdomen. In addition, the doctor should ensure that the patient understands the nature and purpose of the examination, and the reasons for it. The doctor should ensure that the patient has given clear verbal consent and should document this.

Doctors are advised to give patients the privacy to undress and should allow patients to remove their own clothing, only assisting when asked.

ACTION: Ensure that patients are offered a chaperone wherever possible if an intimate examination is necessary. Chaperones must be familiar with normal examination techniques and good conduct.