Informed consent for intimate examination

Health and Disability Commissioner Anthony Hill today released a report finding a general practitioner (GP) in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to establish informed consent for an intimate examination.

A woman attended her first appointment as a new patient at a medical centre, wanting diabetic supplies from her new GP and a transfer to the local district health board’s diabetic services. After discussing her insulin, the GP asked the woman whether she regularly checked her own breasts. The GP then discussed the importance of breast examinations and proceeded to demonstrate how to perform a breast self-examination. The demonstration involved the GP touching the woman’s left breast.

Mr Hill considered that the GP failed to provide the woman with information that she was entitled to receive, including how he would demonstrate self-examination, why the examination was necessary, and that she was entitled to have a chaperone present. As a result, Mr Hill found, the woman was not in a position to give informed consent.

"The principle of informed consent is at the heart of the Code," Mr Hill said.

Mr Hill considered that it was irrelevant whether the GP was performing a breast examination or demonstrating on the woman how to self-examine her breasts: "In all the circumstances, a physical examination was involved, and [the woman] had the right to be given all the information necessary to enable her to give informed consent."

The GP is no longer practising medicine, but Mr Hill recommended that the Medical Council consider whether a review of his competence is warranted if he seeks to renew his practising certificate. Mr Hill also recommended that the GP apologise to the woman.

The full report for case 18HDC01697 is available on the HDC website.