Getting intimate…why you should frankly explain what you are doing when performing a physical examination

When performing a physical examination, relying on implied consent can be risky. Especially with new patients you may not know well. So what do you say to help reduce the risk of a complaint?

Performing intimate physical examinations presents a challenge for doctors and patients, especially when they don’t know each other well.

A lack of adequate communication and appropriate management when examining patients can lead to complaints.

The Medical Council spoke to Dr Walid Jammal and Professor Tony Eyers about this important topic.

Dr Walid Jammal, principal GP at the Hills Family General Practice, believes it is important not to rely on implied consent when communicating about physical examinations.

“With a new patient, you don’t know what their previous experiences are,” he said.

“Even simple examinations can be difficult. You need to explain what you are going to do fairly explicitly - you can’t just say, ‘I’m going to do a vaginal examination’ because your patient may not know what that means”

The more intimate the examination, the more explicit the communication needs to be.

Dr Jammal said this may mean saying things like: “Is it ok if I pull your pants down and have a feel of your groin for lumps” or “Is it ok if I insert my fingers into your vagina to make sure your ovaries are not enlarged, and please tell me if it hurts in any way?”  

In Dr Jammal’s practice, when a patient says they feel feels uncomfortable with the examination he wants to undertake he will ask them if they would like to see another doctor in the practice.

“If a patient needs an examination but feels uncomfortable, someone else needs to do it,” he said. “Patients really appreciate having two doctors, and this is easy to do in group practice.”

Professor Anthony Eyers, a colorectal surgeon and academic with more than 30 years of experience, emphasised the importance of getting to know a patient before performing an intimate physical examination.

“I would never examine until after I have been talking to the patient for a few minutes,” he said. 

Talking to patients while you examine and telling what you are doing at each stage helps patients be more comfortable particularly with intimate examinations.

Professor Eyers said: “You’ve got to keep talking and tell people what you are doing, and explain why you need to do it.

Professor Eyers ensures he schedules at least 20 minutes for all appointments and gives new patients half an hour. 

His top tips for intimate physical examinations are getting to know the patient, being properly prepared,  showing respect for example by providing a curtain for patients to dress and undress in privacy, maintaining good communication to explain the process.

 

Further resources

Sexual Boundaries –Guidelines for Doctors

Medical Board of Australia

https://www.medicalboard.gov.au/codes-guidelines-policies/sexual-boundaries-guidelines.aspx

 

“If a patient needs an examination but feels uncomfortable, someone else needs to do it"