The perils of poor communication

A foundation doctor was asked to clerk a male patient who had been referred to the emergency department by his GP. The GP suspected cauda equina syndrome after the patient complained of severe back pain, numbness in his legs and difficulty passing urine.

The doctor explained to the gowned patient that he needed to carry out a physical examination to confirm the diagnosis and the patient nodded in response and got into the left lateral position as requested. However, as the doctor checked around the perineum for saddle anaesthesia, the patient shouted out in alarm that he was being sexually assaulted. A senior trainee quickly arrived and took over. The doctor was later asked to write a statement as the patient was upset and might make a complaint about him. 

Fearing the incident could mean the end of his career, the doctor called the MDU in distress. 

What happened next

After the medico-legal adviser reassured the doctor and he was calm, she helped him reflect on what had gone wrong during the consultation and the reasons why. Looking back, the doctor regretted that he had not communicated well with the patient before and during the examination so they knew what to expect.

Together they reviewed the GMC's guidance on intimate examinations, which says doctors should explain to the patient why an examination is necessary and what it involves in a way they can understand and give them an opportunity to ask questions. They should obtain and record the patient's consent before starting the examination and offer a chaperone, even if the patient is the same gender.

With the help of the adviser, the doctor produced a factual written account of the incident, apologising for his failure to explain fully and offer a chaperone, and pledging to undergo further training to improve his practice in this area.

To his relief, the patient accepted his apology and did not complain, and the trust investigation of the incident concluded the intimate examination was clinically appropriate. The doctor was supervised directly for the next intimate examination he needed to perform, and communicated extremely well. He also wrote a reflective piece about the role of chaperones in medical practice.

Take-home messages

  • Ensure the patient understands why a physical examination is needed, what is involved and check if they have questions.
  • Record the patient's informed consent.
  • Always offer a chaperone before an intimate examination, even if you are the same gender as the patient.
  • Talk to the patient during a physical examination about what you are doing and why.
  • Reflect on your interactions with patients – were you clear, polite and considerate and did you listen to their concerns? 
  • Seek feedback on your communication skills from senior colleagues and your educational supervisor.

This page was correct at publication on 30/01/2024. 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.