Expressed informed consent for intimate gynaecological examinations

Abstract

The doctor-patient relationship, although extremely important and essential to ensure optimal treatment outcomes, remains complicated. This relationship allows two people, unfamiliar with each other, with different value systems, to share intimate information, and allows the healthcare provider to perform intimate examinations on male or female patients. During the past two to three decades, the doctor-patient relationship has evolved from a mainly paternalistic relationship where the doctor knew what is best for the patient, and “good patients” were regarded as those who submissively accepted the proposed treatment or intervention, to a more patient centred model of mutual participation and decision making in caring for the patient. Although this model is based on equality, shared power and responsibility, the balance of power in this relationship in practice is not equal. The power balance tends to favour the doctor, regardless of how well the healthcare provider executes his or her responsibility in this regard. The patient is frequently in a compromised situation, having a health problem requiring treatment, with not many options than to rely and depend on the doctor’s specialised knowledge and skills. In some settings the patient does not even have the right to choose a healthcare provider of his or her choice and have to accept what is available, regardless of their perception of the individual professional that will be treating them.