Allegations of criminal activity can arise following patient interactions. Dr Emma Davies sets out steps to mitigate any misunderstandings or miscommunications.
Two British Police Constables in uniform standing together
There are about 30 cases a year in the UK where our teams assist doctors facing allegations of criminal activity arising from their day-to-day work.
While allegations of gross negligence manslaughter are brought against doctors, thankfully this is rare. More common, however, are allegations of sexual assault/misconduct or physical assault arising from patient encounters.
The term sexual assault refers to sexual contact or behaviour that occurs without explicit consent of the victim.
Sexual misconduct is uninvited or unwelcome behaviour of a sexual nature, or which can reasonably be interpreted as sexual, that causes offence, embarrassment, harm, humiliation or intimidation. Sexual misconduct includes causing offence by what we say as well as what we do.
Physical assault beyond the obvious can include physically restraining another person. As the need for physical restraint is uncommon in the context of private practice, I will focus on sexual assault/misconduct.
Complaints and allegations of this nature may be made directly to the clinic or doctor, to the police or to the regulator. If made to your clinic, they should always be taken seriously and investigated robustly. Allegations can come from patients of all ages, gender and sexuality.
Understanding how unfounded sexual assault allegations come about can help reduce the risk of it happening to you. Even the most experienced practitioners can find themselves at the centre of an allegation of this nature following a patient interaction.
Communication and adequate consent
What we may think of as routine or necessary may not be apparent to the patient. For example, a patient may not understand why a presentation of painful calves when walking could indicate the need for palpation of a femoral pulse or listening to their heart. Both are intimate areas of the body and are not the place where the pain is.
Taking time to explain your thought process, rationale for examination and what the examination will involve is an essential part of consent.
Offering a chaperone
Patients will differ in what they deem to be an intimate examination and, for some, just being touched or having to be in close proximity to the doctor may be very difficult, especially for vulnerable people.
There may also be cultural reasons why a patient may find an examination distressing. For all intimate examinations and for examinations where your patient appears particularly nervous or embarrassed, you should offer a chaperone.
The chaperone should be suitably trained, familiar with the examination and be able to see what the doctor is doing, if practical.
If a patient declines a chaperone but you feel uncomfortable in proceeding and the examination is not time-critical, you could defer the examination to someone else.
You should make clear notes about the discussion around chaperones and the presence of a chaperone in the consulting room.
Understanding of dignity
Patients should be offered a space to be able to undress in private and have something available to keep them covered as much as possible.
You should not remove a patient’s clothing or start helping them undress unless you have their specific permission to do so.
Behaviour and attitude
Patients need to know that they can trust their doctor; maintaining a professional attitude and taking into account any sensitivities the patient may have is essential.
Making personal remarks or going ‘off topic’ can lead to patients misinterpreting intentions. While humour can sometimes help to put patients at ease, the timing may not always be appropriate and it is advisable to think twice and read the situation carefully before considering making a light-hearted remark.
It is important to maintain awareness of the power dynamic between doctor and patient. If a patient asks you to stop during an examination, you should abide by their wishes.
You should also be alert to non-verbal communication, which may indicate that the patient does not want to continue with the examination.
If you receive an allegation of criminal activity following a patient consultation, always contact your medical defence organisation as soon as possible for advice and support.
Dr Emma Davies (right) is a medico-legal consultant at Medical Protection