Sexual assault allegations are thankfully rare, but numbers are increasing.
Allegations can be extremely distressing for the patient, the doctor and their families, and investigations can be prolonged and damaging to a doctor's career, even where the allegation is proved to be unfounded.
What happens when an allegation is made?
The police will usually inform the GMC when it investigates a complaint of this type, and the GMC will usually wait for the police investigation to conclude before initiating its own investigation.
However, the GMC might suspend or impose conditions on a doctor's registration while the investigations are ongoing, meaning a complaint of inappropriate behaviour can take several months or even years to conclude.
How can you avoid an allegation in the first place?
Bearing in mind that these cases often arise from misunderstandings, there are measures doctors can take to lessen the risk of receiving a complaint.
Familiarise yourself with local and national guidelines
- 'Intimate' examinations are likely to include examinations of breasts, genitalia and rectum, but could also include any examinations where it is necessary to touch or even be close to the patient.
- Follow the GMC's guidance, which explains that doctors should be sensitive to what patients may think of as 'intimate'.
- Be aware of any local policies or procedures.
Get consent for the examination
- Communicate carefully with the patient; this will help to avoid any misunderstanding that might trigger a complaint.
- Explain to the patient, if necessary, why a symptom in one part of the body may require an examination of another area.
- Explain clearly to the patient what is involved in the examination you are about to perform, any equipment you will use, and any discomfort they might experience.
Offer a chaperone
- The GMC states that 'you should offer the patient the option of having an impartial observer (a chaperone) present wherever possible' when carrying out an intimate examination. This applies whether or not you are the same gender as the patient.
- The chaperone should usually be a health professional who has been trained so that they are familiar with the procedures involved.
- A relative or friend would not usually be suitable for this role, but you should consider a patient's reasonable request to have one present.
Give patients privacy to dress and undress
- Ideally, the examination area should be in a separate room, or have facilities to provide privacy, such as a curtain.
Avoid light-hearted or personal comments
- It can be tempting to try to put an anxious patient at ease with some light-hearted conversation, but this can be misinterpreted and may cause offence.
Stop if the patient asks
- A patient may ask you to stop during an intimate examination, for example, if they experience discomfort.
- Consent to a procedure can be withdrawn at any time and for a number of reasons, and you must respect and comply with this.
Keep careful records
- Document the discussion you have had with the patient to obtain consent, including why the examination was clinically indicated, the fact that you offered a chaperone, and whether the patient accepted or declined.
- If a chaperone is present, make a note of their name and job description in the clinical records.
- The GMC accepts that a doctor may proceed with an intimate examination without a chaperone as long as both the patient and doctor are in agreement; however, having a chaperone present can strengthen a doctor's defence if an allegation of unprofessional behaviour is made.
In the unlikely event that you become aware of a sexual assault allegation being made against you by one of your patients, contact the MDU as soon as possible for support and advice.
See also our detailed guidance on chaperones.
A GP was asked to give a statement to the police after a 44-year old female patient made an allegation that the doctor had stared at and stroked her breasts during a consultation.
The GP remembered examining the woman for a possible respiratory or cardiovascular problem as she was complaining of a persistent cough and had fainted. He had not offered a chaperone because he did not consider it to be an intimate examination.
The GP, who was an MDU member, was interviewed under caution by the police in the presence of an MDU solicitor and denied any inappropriate behaviour. The GP stated that he had explained to the patient that he needed to examine her chest, and that she had agreed to this. The GP listened to the back of the patient's chest and performed a cardiovascular examination, which involved palpating the patient's sternum and an area below her left breast. He also placed his stethoscope over the upper and lower part of the patient's chest above and below her bra. He explained that the only time he touched her breast was when he lifted the left breast in order to feel beneath.
The GMC began an investigation and the GP attended an interim orders tribunal hearing where he was represented by a barrister provided by the MDU. The MDU barrister successfully argued that the GP should be allowed to continue to work, provided he had a chaperone present for all consultations with female patients, which would need to be logged.
Some six months later, following a favourable expert report, the police closed the criminal investigation as they were satisfied that the GP's examination was clinically appropriate.
The GMC then began to fully investigate the complaint. With the help of the MDU solicitor, the GP provided a detailed statement to the GMC, explaining that the examination was clinically indicated and performed appropriately, but acknowledging that in this case he could have provided a more detailed explanation to the patient as to what was involved and why it was required.
The GMC case examiners were satisfied with this explanation and closed the case after a seven-month investigation. The GMC advised the GP about the use of chaperones and the need to get a patient's fully informed consent before examining them. The conditions imposed by the interim orders tribunal were lifted, and the GP was able to resume normal practice. However, the case had taken 14 months to conclude, and the media coverage it attracted in the local press during that time caused enormous emotional distress for the GP and his family.
This guidance was correct at publication 27/07/2018. It 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.