Dr Duckworth’s research
Dr Jess Duckworth (aka ‘The Piano Doctor’) is a specialist trainee in Community Sexual and Reproductive Health (CSRH). During her medical degree, she intercalated and completed a master’s degree in medical humanities, as part of which she submitted a dissertation entitled ‘Music in the Waiting Room’.
As most of us know, music can have an enormous effect on how we feel. Dr Duckworth told me that research shows music can not only reduce anxiety but can also increase one’s pain threshold. That made sense to me; my dentist often plays jazz during our appointments, which helps me to relax.
It occurred to Dr Duckworth that the patient journey does not begin in the consultation room; it begins long before and includes their time in the waiting room. She investigated not only whether people find it helpful to hear music played in waiting rooms, but also which musical characteristics (pitch, tempo, rhythm, melody, tonality and texture) they find most calming.
Based on her findings, she composed an hour-long album of piano music for use in medical waiting rooms to reduce patient anxiety. The album was then played in a hospital waiting room and most of the patients surveyed reported feeling more relaxed as a result. She hopes that one day, music in waiting rooms will become the norm.
Don’t make assumptions; some patients may look calm but feel anxious, and it doesn’t always occur to patients to let you know when they are feeling anxious.
Complaints arising from vaginal examination
My interview with Dr Duckworth caused me to reflect on three particular cases I have dealt with during my time at the MDU; one GMC investigation into a consultant gynaecologist arising from a vaginal examination, and two NMC investigations into GP practice nurses arising from cervical screening. These resulted in allegations of:
- rudeness
- forceful vaginal examination
- lack of consent
- failure to use lubricant.
The clinicians concerned were experienced at performing vaginal examinations and were regarded by colleagues and patients as being kind and empathetic. From reading their complaints/witness statements, it appeared that the complainants might have been feeling extremely anxious before their consultations.
I wondered whether this might have affected their perception of the clinician’s manner and the forcefulness of the examination. Did it also influence their ability to provide a full and accurate medical history, or to absorb and recall information (especially during the consent process)? And what, if anything, might have reduced their anxiety and avoided their complaints?
Given matters such as music licensing requirements, the need for specialist equipment, and budgets, it may not always be possible or practical to play music in a waiting room. So, what else can be done?
How to help patients address anxiety
Dr Duckworth shared with me her tips on making patients feel at ease during vaginal examinations.
- Don’t make assumptions; some patients may look calm but feel anxious, and it doesn’t always occur to patients to let you know when they are feeling anxious.
- Collect the patient from the waiting room to observe their behaviour/the way they hold themselves, to try to assess how anxious they might be feeling. Walking to the consulting room with the patient also offers the opportunity to build rapport.
- Don’t assume the patient has had a vaginal examination before. Check what they know and take time to explain what it entails.
- If they have been examined before, ask them what their experience was like.
- Reassure the patient that they are in charge. If a patient is particularly anxious, you might want to consider giving them the option of self-inserting the speculum. This might be particularly helpful if the patient has a history of sexual assault or vaginismus.
- Let them know that if they say ‘pause’, the examination will be paused.
- The environment is really important. As far as possible, ensure the room is not too cold. Make sure there is somewhere for the patient to put their clothes. Close the curtains and inform the patient the door will be locked so no one can walk in.
- A good chaperone is invaluable. Offering to hold the patient’s hand can be of great comfort, and talking to them during the examination an excellent distraction.
- Cover them with something so they don’t feel exposed.
- Ask if they would like to know what is happening during the examination or if they would prefer not to know the details.
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Responding to complaints arising from vaginal examination
Regarding the three cases I mentioned earlier, members may be interested to know that they all concluded with no further action. In each case, as well as providing the clinician’s recollection of events, we also provided evidence of the absence of previous concerns and current fitness to practise, evidence of remediation and reflection, and evidence of mitigation.
Here are some examples of the type of evidence it might be useful to produce when responding to a regulator about a complaint of this nature:
Factual evidence
- Witness statement from the chaperone, providing their version of events.
- Entry in the medical records confirming, for example, that consent was obtained, that a chaperone was present, or that lubricant was used.
Colleague and patient feedback
- Supportive testimonial letters from colleagues (both clinicians and administrative staff).
- Anonymised thank you cards.
- Multi-source feedback from patients and colleagues.
Evidence of mitigation
- Was the examination difficult to perform for any reason?
- Was there anything wrong with the examination couch or other equipment?
- Was the chaperone inexperienced?
Evidence of reflection and remediation (even if you deny the allegations)
- Completion of relevant CPD activities - not just attending courses but also reading material on, for example, gynaecological examination, empathy, consent, communication skills and psychosexual medicine.
- A short reflective document detailing what you learned from each CPD activity and how you have changed your practice as a result.
- An anonymous survey of patients on whom you have performed a vaginal examination or cervical screening since the complaint.
- Feedback from a senior clinician invited to observe a consultation and vaginal examination or cervical screening procedure, with the patient’s permission.
Final thoughts
On a personal note, Dr Duckworth’s research has caused me to think more about the negative effects of stress and anxiety on my own performance and the positive effect of music on my wellbeing. Perhaps we should play relaxing music to clinicians and lawyers too!
You can read more about Dr Duckworth’s medical and musical journey in an article she recently wrote for the MDU Student Hub.
Bansari Patel
Bansari Patel qualified in 2009 and joined the MDU in 2015. She represents members at the GMC, NMC and at inquests.
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