1. VICTORIAN INSTITUTE OF FORENSIC MEDICINE Sexual Assault in the Consultation Room Dr Angela Williams Clinical Forensic Medicine

2. VICTORIAN INSTITUTE OF FORENSIC MEDICINE The examination of a patient’s genital anatomy is a very important diagnostic tool when indicated but it is an intimate examination that is uncomfortable (both physically and mentally) for most patients

3. VICTORIAN INSTITUTE OF FORENSIC MEDICINE Common scenarios 17yo girl has a pap smear Notes that her friends did not have the same thing done Appropriate examination Inappropriate communication 28yo lady attends for a sexual health check He locks door and asks to pull underwear aside Appropriate examination Inappropriately done

4. VICTORIAN INSTITUTE OF FORENSIC MEDICINE Common scenarios 35yo lady expects a vaginal examination Inappropriate examination Appropriately done 34yo lady who is 37 weeks pregnant attends for routine antenatal visit Inappropriate examination Inappropriately done

5. VICTORIAN INSTITUTE OF FORENSIC MEDICINE Appropriate examination Inappropriate communications Consent Language Cues Preparation Choice of words Appropriate examination Inappropriately done Gloves (lack of) Privacy Undressing Positioning Touching/stimulation Inappropriate examination Appropriately done Clinical Indication Medical purposes Consent + Cues Opportunistic Medicine? Inappropriate examination Inappropriately done Clinical skills Communication skills Knowledge, behaviour, attitudes

6. VICTORIAN INSTITUTE OF FORENSIC MEDICINE By what do patients measure their experience?

7. VICTORIAN INSTITUTE OF FORENSIC MEDICINE Why don’t we hear about sexual assault in the consultation room?

8. VICTORIAN INSTITUTE OF FORENSIC MEDICINE Harm… Professional conduct during genital examinations – Patients have an expectation that the practitioner from which they seek medical advice and care has adequate knowledge, experience, and skills to appropriately conduct such examinations. In particular, attention must be given to informed consent, dignity and privacy when conducting these examinations. It is wise to consider the presence of a chaperone during intimate examinations and procedures.

9. VICTORIAN INSTITUTE OF FORENSIC MEDICINE A doctor’s communication skills are the basis upon which an appropriate and effective doctor-patient relationship can be formed. Without such there is a great risk of miscommunication, wrong diagnosis, mistrust, fear of ongoing medical practitioners, inappropriate examinations, lack of patient consent to examination and procedures and the possibility of assault. Harm to whom?

10. VICTORIAN INSTITUTE OF FORENSIC MEDICINE Good practice… explaining to the patient what is to occur in the examination and providing an opportunity for the patient to ask questions gaining the consent of the patient to conduct an examination being sensitive to any sign the patient has withdrawn consent not continuing with an examination when consent is uncertain, has been refused or has been withdrawn allowing a patient to undress and dress in private. A doctor should not assist a patient to undress or dress unless the patient is having difficulty and requests assistance providing suitable covering during an examination using gloves when examining genitals or conducting internal examinations not allowing the patient to remain undressed for any longer than is needed for the examination gaining the patient’s permission if anyone else, including medical students, is to be present during an examination or consultation allowing a patient to bring a support person who may be a family member, close relative or friend Section 8 Professional standards in physical examinations of the Medical Board of Australia’s document entitled Sexual Boundaries: Guidelines for Doctors

11. VICTORIAN INSTITUTE OF FORENSIC MEDICINE Where to from here? I have serious concerns regarding the case presented to me and the professional conduct of the medical practitioner. I therefore recommend the ongoing investigation of this case by Victoria Police and for the referral of this matter to the Australian Health Practitioners Regulation Agency.