By Lydia Akinola
Let’s be honest – intimate examinations are difficult. Not just for the patient, who is understandably nervous and unsure, but for the clinician too. You want to be slick and unawkward, and for your consent to be one for the textbooks. But, in reality, you often find yourself in a poorly lit, poorly laid out room with a patient who is already wary of where the consultation is going. Your brain is working out potential differential diagnoses, and your mouth is somewhere between medical jargon and verbal diarrhoea. Here are some tips that may help.
Tip no. 1: do nothing without a chaperone. Not the patient’s family or friend, but a healthcare professional such as a healthcare assistant, nurse, midwife or if all the above are busy, another doctor. This is to protect you as well as the patient. The chaperone should be named and documented in the notes. If the patient refuses, explain why this is essential and stress that you cannot go ahead without a chaperone.
Take your time. This is NOT something to be rushed.Lydia Akinola, junior doctor
My next piece of advice – take a breath. Take your time. This is NOT something to be rushed. Imagine if you were the patient; you’d want the respect that taking an appropriate amount of time affords. This applies especially to explanations and consent. If need be, be blunt.
For example: ‘I am going to need to examine your groin, which means that you will need to take your pants off. I will be feeling for a lump in your testicles. Is this okay?’ Or: ‘Is it okay if I perform a vaginal examination? This means I will need to put my fingers in your vagina to assess how dilated you are. Please let me know if you want me to stop as this may be uncomfortable. Is this okay?’ You need to have informed consent; you should give them the option not to have the examination, but the risks and benefits should be discussed and documented.
Make sure you ask the patient if they have any concerns or questions before you begin. If the patient raises any issues, such as experience of sexual abuse which may make the examination more difficult for them, provide reassurance and understanding, and make sure they’re comfortable and happy to give their consent.
Try to develop a patter, a spiel, for examinations that you do often. ‘I’m going to do a rectal examination, which means that I’m going to put a finger into your back-passage to see if I can find the cause of the bleeding you’re experiencing. I will be as quick as I can as I don’t want to cause you discomfort. I will need you to pull all your bottom clothes down to your ankles and then lie on your side on this couch here with your knees up high – like a ball.’ This gives the patient confidence that you know what you’re doing, that you’ve done it before and you’re a professional.
Equally important is that you have your equipment ready – don’t let the patient get undressed if you don’t have all the kit you need. They shouldn’t feel unnecessarily exposed and vulnerable because you’re faffing around trying to find lubricant.
Finally, be gentle! I hope I don’t need to explain why.
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