Asking a sensitive question? Clarify the purpose

Communication between doctor and patient can be challenging and easily lead to complaints with doctors unnecessarily going before regulators.  A situation especially open to the dangers of misinterpretation is after-hours visits to private residences.

Home visit

Such a situation was faced by a GP member who was called to provide an after-hours home consultation as part of a home-deputising service. The patient, a woman in her 50s who lived alone, was complaining of flu-like symptoms and a sore throat.

The GP obtained a history from the patient and noted, in the clinical record, swollen lymph nodes in her left neck and a pain in the left side of her throat and ears, as well as other symptoms of infection.

He performed a physical examination, including taking the patient’s temperature and heart rate, as well as an examination of the throat and ears. He observed there was reddening in the left oropharynx with pus on the left arch.

After the physical examination had concluded, the GP provided his recommendation for further management and asked the patient whether she was sexually active. He recalled the patient appeared taken aback by this question and declined to answer. He then left.

The patient complained to AHPRA that the GP had made her feel uncomfortable by asking about her sexual history and that there was no reason to ask the question.  She also claimed the doctor made her feel awkward by sitting so close to her while he was examining her.

The GP told the Medical Board there was a clinical justification to ask about the patient’s sexual history because his findings of pus on the left pharynx and prominent lymph nodes led him to consider the possibility of the transmission of an STI. He explained he needed to sit in close proximity to the patient in order to examine her throat and ears.

The Board’s investigation

Upon receipt of the notification, we met with the doctor and worked on a plan that would demonstrate his clinical competence to the Board, and explain this was simply a case of a miscommunication.

From our understanding of the Board’s assessment of notifications, one of the steps taken was for our member to enrol in a personalised education plan to minimise the regulatory response from the Board.

This was done with assistance of Avant’s Risk Advisory team, in order to demonstrate the doctor’s willingness to consider what could have been done better.

The education covered topics such as effective communication, professional boundaries and patient-centred information gathering.

The Board subsequently decided that the GP had provided adequate clinical justification for his questions, which were supported by the clinical records. The Board also noted the GP had demonstrated insight, acknowledged his communication could have been better and had already enrolled in further education, so decided to take no further action.

Case comment

Dr Kelly Nickels, MBBS (Hons), FRACGP, M Hlth & Med Law, Practice Manager Claims – Non-civil, Avant Vic.

The GP accepted he should have asked the question about the patient’s sexual history immediately after he had finished the physical examination of her throat, and contextualised the question by explaining why the patient’s sexual history was relevant. The GP could have also put the patient at ease by explaining that he needed to sit next to her on the couch to examine her ears and throat.

Practitioners should bear in mind that providing an after-hours consultation in a patient’s home, particularly when the patient is alone, can make the patient feel vulnerable. There is an increased need for the doctor to put the patient at ease by:

• being very clear about each step of the consultation
• providing context for questions about the patient’s history that may make them feel uncomfortable or embarrassed (such as their sexual history)
• inviting an adult member of the patient’s family to be present during the consultation if the patient wishes.

Useful resources

Read our factsheets Dealing with a professional conduct complaint and Connecting with patients.

This article was originally published in Connect Issue 9.