Concern previously restricted to the practice of Gynecology and Obstetrics, the presence of a companion during examinations is currently a matter of concern to Radiology - at least from the perspective of certain specific segments of Diagnostic Imaging.
In fact, complaints made by patients regarding crimes of a sexual nature allegedly occurred during radiological examinations have an increasing incidence in the police sphere and in the sphere of action of the Regional Medical Councils (CRMs) and the Federal Council of Medicine (CFM).
Cases of this kind involve potentially complex factual situations - from a probative point of view: in the vast majority of them there is no testimonial or material evidence, and their solution invariably involves only analysis of the parties' allegations (revealed by the utmost “word of a against another's word ”).
Based on such a context and perspective, specifically on those exams where sensitive or intimate parts of patients are being handled, such as mammography, hip exams and, in some cases, ultrasound, the idea is strongly recommended. a companion in the room during the medical act.
The logic hitherto developed stems from some relevant precedents of CRMs, in cases that can be perfectly, by analogy, applied in the area of Diagnostic Imaging:
“It is recommended that the doctor perform a breast or gynecological examination in the presence of a Cheers/ family member or companion. It is the responsibility of the manager of the Health Unit to compose its staff to provide the service it proposes. The BPA being of statistical and administrative character must be completed by the administrative assistant or room attendant. ”(Opinion CREMEB No. 03/09 (Approved at the 1st Chamber Session of 01/05/2009).
“Recommendation No. 01/88 - CREMESP, which: Considering the large number of complaints referred to this Council by the Police Station regarding sexual abuse in gynecology; Whereas law enforcement authorities have repeatedly filed charges with doctors regarding the filing of a criminal complaint against patients, alleging that they have been subjected to acts of “violence and / or sexual abuse”; Considering, furthermore, that the analysis of these complaints often reveals absolute ignorance of patients regarding breast exams and / or poor care of what may be a “specular exam” or “touch exam”, confusing them with “ lewd acts ”; Considering, finally, the difficulty of proving the occurrence of the facts, being generally the patient's word against the doctor's; It is recommended that: 1. When treating patients undergoing gynecological examinations, physicians preferentially practice the referred medical acts in the presence of the patient's assistant and / or companion; 2. explain to patients in advance and in detail the procedures that will be performed during the gynecological examination, in compliance with the provisions of article 46 of the Code of Medical Ethics ”.
This is, of course, a recommendation that seeks to protect the position of the radiologist and his patient, inserted in a context of intense judicialization of relationships and which must be faced according to the rules of experience of each professional and according to the characteristics of each patient. each exam.
If the patient himself does not have a companion to witness the examination, it is recommended that the radiologist have his own assistant, who should remain in the room during the procedure. Note that the radiologist is a professional with autonomy, so if the patient does not agree with the presence of an assistant, the doctor may refuse to perform the exam.
DR. ALAN SKORKOWSKI
CBR legal advice