A breach of sexual boundaries comprises any words, behaviour or actions designed or intended to arouse or gratify sexual desires. It incorporates words, actions of behaviour that could be reasonably interpreted as sexually inappropriate or unprofessional. It is not restricted to a male professional and a female patient – a male or female medic can breach a sexual boundary with either a female or a male patient.
Healthcare professionals have a duty to ensure the safety and well-being of their patients. A patient must feel confident and safe so that they can be treated effectively and participate effectively in their care. When conducting an examination consider how you perform under the following headings:
Communication with the patient – before an examination explain what you are going to do and why, what the patient might feel, whether there will be discomfort and conclude by asking the patient if they have any questions before you conduct the examination.
• Disrobing – if the patient needs to undress for the examination, it is essential that there is a place they can disrobe in private. The healthcare professional needs to manage this in a way that maintains the patients dignity and privacy as much as possible. Instruct the patient only to remove the relevant garments. Refrain from any personal comments or irrelevant questions during the examination. Once the examination is complete provide a sheet/blanket for the patient to be covered and/or allow the patient to dress again and then sit face to face to discuss the examination.
• Engage an observer. Either a medic or a patient may request a 3rd party to be present during an examination. Ensure that the patient understands that a 3rd party can be present if they wish. An observer may be present for a variety of reasons:
o Support for the patient
o Interpreter for the patient
o Observer for the medic
o Student or trainee
o A chaperone for the medical professional
• Acknowledging cultural differences – medics must be sensitive to cultural differences. For example, in some cultures modesty is very important and embarrassment can be caused easily. In others it is considered inappropriate for a male to examine a female patient. In some traditions men will always be present during a medical examination of their wife and for others over-familiarity (use of first names, casual chat) can be too personal and cause distress.
In the absence of strict definitions in the Republic of Ireland, Dignity 4 Patients refers you to the definitions set out by the Medical Council of New Zealand.
The Medical Council of New Zealand have published a guideline document for doctors however it is a useful resource for any medical professional.