A GP declined to carry out a breast examination on an unaccompanied young girl without a chaperone
The scene
A male GP was carrying out morning surgery when he called in the next patient. She was a 15-year old girl attending alone. She explained she was very worried because in the shower a few days ago she thought she'd felt a breast lump. She was tearful and anxious. She had not told anybody else about this and was very worried because her maternal grandmother had died in her 60s of breast cancer.
The patient was clearly very upset but was keen to be examined there and then. The GP explained he would like to discuss the matter further with her and that if he were to proceed with a breast examination he would like to have a chaperone present.
The patient became very distressed and said she did not wish anyone else to be present and wanted the examination to take place as soon as possible. The GP asked the patient to take a seat in the nurse's room while he took advice. He felt that as she was so upset he could not send her back into the waiting room. The GP called the MDU advice line seeking guidance on how to proceed.
MDU advice
The MDU adviser explained that GMC guidance highlights that before conducting an intimate examination a doctor should explain to the patient why the examination is necessary, and give the patient a chance to ask questions, explain what the examination will involve in a way the patient can understand so they have a clear idea of what to expect. The doctor should get the patient's permission before the examination and record it. The guidance also states the patient should be offered a chaperone.
If dealing with a child or young person, the doctor should assess their capacity to consent to the examination and if they lack the capacity to consent the doctor should seek their parent's authority.
The GP felt in the circumstances the patient was so distressed that she did lack capacity to consent to the examination, notwithstanding his own reluctance to carry out an unchaperoned breast examination on such a distressed young patient. In discussion with the MDU adviser, the GP concluded that the examination was not immediately necessary and could be deferred to a more appropriate time.
The MDU adviser suggested the doctor speak to the patient again and try to offer her as much reassurance as possible and explore with her whether there was an older friend or family member she could confide in and who might attend with her for a detailed consultation and examination.
Outcome
The GP contacted the MDU after the consultation to feed back that when he had spoken to the patient again he had explored with her the reasons for her anxiety. She remained upset but had settled down a little. He talked to her about the possibility of involving an adult relative or friend in a future consultation so that they could provide her with emotional support. At that point, the doctor offered to contact the patient's mother himself to explain the patient's concern and to ask if she would attend with the patient for a consultation and examination. This is what transpired and the patient was seen the following day with her mother when the GP was able to reassure them both that there were no suspicious findings from the history or examination.
Dr Catriona James
Medico-legal adviser
This page was correct at publication on 10/02/2014. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.