An MDU member called the advice line to explain that he had been accused of an inappropriate examination of a young girl.
He had examined the child a week before the complaint was made by her mother. During the appointment it had been necessary to examine the patient's inguinal lymph nodes. As her two older brothers were also present, the girl was examined on the couch with the curtains drawn around her, in order to preserve her privacy. The doctor - a GP trainee - asked the mother if she would like to come behind the curtain too, but the mother declined.
After the patient had left the consultation room it appeared that she was upset, and on further questioning told her mother that the doctor had touched her genitals. The mother called the practice and complained.
At the time of contacting the MDU, the doctor had been made aware of the complaint but was uncertain how it would progress. From there the situation shortly escalated to a police and GMC investigation.
Here the doctor explains how the events unfolded, the effect this had on him and his lessons learnt regarding the use of chaperones.
The doctor's story - first reactions
I had not realised the gravity of the situation until after multiple contacts became involved, including my educational supervisor, medical director, social services, and the police.
Initially, it was an obvious misunderstanding, rooted in fear and emotion on behalf of a vulnerable patient, that could easily be explained in three words; it didn't happen. When my clinical supervisor informed me of the complaint, I understood what he said, but the solution was clear; to explain to the parent that the child was mistaken. I denied any wrongdoing, and this was relayed to the family.
After the complaint
When told about the complaint, it was suggested that I contact my defence union almost immediately. The practice, too, would contact their defence union. Upon speaking to the helpline, I was allocated to a medico-legal adviser.
The MLA had experience in handling a complaint of this nature, which was reassuring, and took me through the process. I was advised that complaints like this often get further investigated and we discussed various permutations that might occur.
I was advised to write down everything I could remember. The MLA proofread my statement before we agreed on a final draft that would be read aloud at a planned meeting between myself, my clinical supervisor, the practice manager, and the patient's guardian two days after the initial complaint was received.
My educational supervisor had warned me that if the complaint was not settled at the planned meeting, it would likely be escalated to social services and/or the police. This is when I started to realise that this may not be something that would just blow over with a simple explanation.
Every second felt like hours until that meeting. Ten minutes prior to it taking place, I was informed that the patient's guardian had cancelled, and instead had escalated the complaint to social services. This is when it felt as if my world was beginning to implode.
I started to realise that this may not be something that would just blow over with a simple explanation.
The investigation stage
What happened next was quick and protocol driven. Given the nature of the complaint, social services had immediately escalated it to the police. I informed my medical director who, in turn, put me on immediate special leave. Within six hours of the meeting being cancelled, the police called me in to the station to be questioned. I had been keeping in touch with the MDU throughout the day, but now I needed a lawyer.
I was arrested for questioning when I arrived into the police station, and I wasn't allowed to make any phone calls; the police would make them for me. I have long been categorised as a determined and ambitious trainee; I sat my postgraduate examinations years early, have numerous publications, and received glowing references and feedback from nearly all my supervisors. But when I was sitting in that cell for hours waiting for the MDU-appointed solicitor, it felt like none of that mattered.
When the solicitor arrived, we spoke about the case at length prior to being formally interrogated and given the opportunity to respond to the complaint. I read aloud my MDU-verified statement, and a few relatively straightforward questions later I was released on bail for four months, with my main condition being not to talk to the complainant.
In four months' time I would find out if the Crown Prosecution Service wanted to take forward the case from a criminal standpoint; whether there was enough evidence to find me guilty beyond a reasonable doubt. To ascertain this, they had my testimony, the patient's, and were going to obtain an expert opinion. Following discussion with my solicitor and educational supervisor, I self-referred to the General Medical Council.
I didn't eat properly, sleep properly, or manage to leave the house for some days.
Even though social services had recommended that I was banned from any medical work, this was ultimately for the hospital to decide. I was given paid 'special leave' and referred to an interim orders panel at the GMC, which decided I could still practise but with special restrictions (namely not to examine a child without a chaperone). It was only at this point, six weeks after the matter, that the hospital decided to let me back into non-clinical training for a period of time.
I had already failed my training for that year and would not progress in my Annual Review of Competence Progression. This had a significant knock-on effect as I was due to switch training programmes and enrol in a different specialty training programme in a few months' time. This offer was threatened to be retracted if the matter did not resolve in a few months' time.
I was able to cope with the complaint, being in a cell, and dealing with the legalities of the situation. But what would happen if the case was not resolved in a few months' time? What would I do for the rest of the year, and my life? Would I be able to get onto another training programme? Would this ruin the rest of my life?
Every day whilst I waited for the CPS to make their decision felt impossible to get through. I didn't eat properly, sleep properly, or manage to leave the house for some days. What was the point? It felt extremely hopeless.
From criminal to civil
At four months' time, the CPS decided not to take the case forward due to lack of evidence. They concluded it was essentially a 'he said, she said' story, and it was impossible to identify what had actually happened, and certainly not beyond a reasonable doubt.
In light of the outcome of the criminal investigation, I was ecstatic, but knew there was still some way to go. The GMC now had to investigate the matter from a regulatory perspective. Just because I couldn't be convicted beyond a reasonable doubt, it didn't mean that the GMC could not investigate the case - particularly as they work on the balance of probabilities rather than beyond reasonable doubt.
This was something my solicitor, the GMC, and my training programme had mentioned, but in fact it took more time to resolve than the criminal matter itself. The GMC called me back and removed my restrictions, as they said it was a disproportionate response to continue imposing restrictions on me in light of the outcome of the police investigation.
It helped to have an outstanding case support worker at the GMC who would regularly update my solicitor with the progress of where my case had been. He recognised the anxiety I was facing as I was forwarding on letters from my incoming training programme in order to expedite the processing.
About nine months after the fact, I will never forget the day I received the email; 'closed with advice'. I called everyone who knew and I took the day off work. The decision had been made in time so that I deferred to my new training programme and the offer was not revoked.
What I learnt was less obvious. As always, I never intend to intimately examine a child without a chaperone present, but as per GMC guidance, this should also follow for examinations that could be 'perceived' to be intimate, which is a significant wider catchment. If I do a respiratory exam, should a chaperone be in the room? What about a lower limb examination?
I've learnt now that parents are not the best sources as chaperones, and instead you should use trained members of staff. Consultant paediatricians and general practitioners who I've discussed this case with admit that this is incredibly difficult to execute in clinical practice.
This article is based on real events and has been published with permission, but some details have been changed to preserve the anonymity of those involved.
The views expressed in this article are those of the member concerned, and do not necessarily reflect the views and policy of the MDU.
For more detailed guidance on the use of chaperones, see the MDU website and review the GMC's 'Intimate examinations and chaperones' (2013).
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