![]() ![]() the patient is a child or young person or there is an impairment which suggests they may not be able to consent to the examination.a patient consults with you after hours and you are alone in the practice.a woman attends for the first time with a problem requiring breast, anal or genital examination.there are any communication difficulties or language barriers, for example the patient is from a non-English speaking background.conducting an intimate examination on any patient, regardless of how long they have been your patient.In other circumstances, this may lead them to feel more uncomfortable or embarrassed and there may be a risk of them disengaging with care. For young people, depending on the circumstances, you may wish to suggest having an observer present to help the patient feel at ease. Practically, it is likely that an appropriate adult will always be present when examining children. Once trust and confidence have been established, you may consider the routine offer of an observer is not necessary. The practice of medicine depends on trust and confidence between doctor and patient and appropriate physical examinations are a vital part of the doctor-patient relationship. If so, you are able to decline to conduct the examination, if it is not urgent, and consider referring the patient to a colleague or other further steps depending on the clinical situation. Or, you may still have concerns and consider that an observer is needed. If the patient does decline your offer, discuss the patient’s reason and you may then be comfortable proceeding with the examination without an observer. Many patients may not want a third person present during their examination and will decline the offer. if a patient appears particularly uncomfortable/reluctant/ distressedīe aware, as the guidelines highlight, that what a patient considers to be an intimate examination may be affected by their cultural values and beliefs, so it is important to be alert to signs of a patient’s discomfort or reluctance.Įxercise your professional judgement to determine when the offer of an observer is appropriate.when one is requested by the patient, during an intimate examination.The AMA’s position statement identifies circumstances where a medical practitioner may wish to have an observer present including: The Medical Board of Australia’s Guidelines: Sexual boundaries in the doctor-patient relationship do not specify when an offer of an observer should (or must) be made. The scope of this aspect of the chaperone role has changed and may now also be referred to as a ‘practice monitor’. *Note: The term chaperone was also used to refer to the situation whereby a doctor has a continuing condition on their registration that requires them to be monitored in compliance with Ahpra conditions. The presence of an observer may also provide some protection for you in such a situation. Regardless of your intentions, if a patient perceives that your remarks are inappropriate or that your examination was insensitive or improper, they may complain. It can be reassuring to a patient who is fearful, vulnerable or embarrassed. The presence of an observer (previously called a chaperone*) as a witness to a medical examination may benefit both you and the patient. If an observer is present, record their name and title in the medical record. It is important to document all offers for an observer to be present and the patient’s response.Before examining a patient, always explain the nature of the examination and the reason for performing it and obtain consent.During some patient examinations, observers may be helpful to reassure the patient and to protect the doctor. ![]()
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