A touchy subject

As a GP, the main priority is to efficiently relieve any worries and stresses you and your patient may have regarding suspected pathology.  However, it is important that you ensure the patient retains autonomy, your communication is clear and that consent is given.  Failure to do so can lead inadvertently to complaints or even allegation of inappropriate actions.

Every patient is different, so it’s important to treat every patient as an individual and to respect their privacy and dignity.

Guidance from the GMC states: "Intimate examinations can be embarrassing or distressing for patients and whenever you examine a patient you should be sensitive to what they may think of as intimate. This is likely to include examinations of breasts, genitalia and rectum, but could also include any examination where it is necessary to touch or even be close to the patient.”¹

The options

A patient should always be offered a chaperone when an intimate examination is to be carried out, but when the patient lives alone or no chaperone is available, the best thing to do is step back and consider whether the examination is urgently required or not. If it’s not, then you should try and rearrange the appointment for a time when a chaperone is available.

If the examination is urgent and there’s enough information in a patient’s medical records to indicate they may need hospital admission, then you may be able to admit them first without performing an examination.

However, if the examination urgently needs to take place and there is no justification for a hospital admission, then a doctor may find themselves in a situation where they need to go ahead with the examination without a chaperone.

If you are going to conduct an intimate examination during a home visit, you need to be able to clinically justify the reason for the examination and why it was required without a chaperone being present.  Having a chaperone protects both the doctor and the patient – it’s very rare for a doctor to be accused of assault if there’s a chaperone present.

Take note

Before an examination does take place, you first need to assess the patient’s symptoms and take into account their medical history. You also need to understand their views and values and consider any psychological, spiritual, social and cultural factors.

The nature of the intended examination should be carefully explained to the patient, and their consent obtained and recorded before you go ahead. This is vital in preventing the possibility of any misunderstanding and giving the patient a chance to decline. They also need to know what to expect in terms of any pain or discomfort. It’s very important to record that the examination took place without a chaperone and to detail the rationale for this.

It’s understandable that during a home visit a doctor wouldn’t want to delay an urgent intimate examination, but when a patient is home alone, it’s crucial that the appropriate steps are taken. These situations often arise when you least expect them – if you have any concerns or questions then contact Medical Protection for expert advice.