Doctors are expected to ensure patient understands what examination entails: review board

Woman alleges medical professional inappropriately touched her breast at exam

Doctors are expected to ensure patient understands what examination entails: review board

In a case where a patient complained that a doctor inappropriately touched her breast during a physical examination, a tribunal held that the inquiries committee conducted an adequate investigation and came to a reasonable decision to take no further action.

In January 2022, the patient visited the doctor’s office for a consultation regarding a cyst on her thyroid. She alleged that the following occurred during the appointment.

The doctor called her into his office and directed her to remove her jacket. He reviewed her test results, brought his chair toward hers, and told her that everything was okay. He placed a wire in her nose then a stethoscope over her thyroid region. He then moved the stethoscope toward her chest, then her stomach, then under her left breast. He did not explain to her what he was doing.

The patient, who believed due to her culture that she should not be alone with a doctor, felt scared and stressed by what happened. She filed a complaint against the doctor. With an interpreter’s help, she gave additional information to investigators during an in-depth telephone interview.

In his response, the doctor explained what he did that day. He examined the patient’s ears, nasal cavity, oral cavity, and oropharynx. He palpated her neck and thyroid region and detected no masses or nodes. He placed a stethoscope over her trachea in the anterior neck, above the clavicles, and over her upper back over her clothing. He examined her upper airway and vocal cords with a flexible nasopharyngoscope.

The doctor denied putting the stethoscope anywhere else on her body, including her lower chest or breast, or underneath her clothing.

After investigating the complaint, the Inquiries, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario chose to take no further action but noted that all physicians were expected to obtain consent before examining a patient and to ensure that the patient understood what would be occurring as part of the examination.

The patient requested a review of the committee’s decision. She argued that the committee wrongly believed the doctor and should have investigated her complaint more deeply.

Doctor wins before review board

In Betzoo v Katyal, 2023 CanLII 111770 (ON HPARB), the Ontario Health Professions Appeal and Review Board – under s. 35(1) of Ontario’s Health Professions Procedural Code, 1991 – confirmed the committee’s decision to take no further action, while also noting that physicians were expected to obtain consent before examining a patient and to ensure that the patient understood what would happen in the course of the examination.

The review board acknowledged that the patient was dissatisfied with the outcome. However, it held that the committee conducted an adequate investigation and arrived at a reasonable decision.

The review board found that the investigation covered the events and obtained the relevant information and documentation from the patient, the doctor, and his administrative assistant to assess the complaint regarding his conduct and actions. These documents included medical records and the doctor’s contemporaneous medical notes from the examination.

The committee transcribed its phone interview with the patient and also interviewed the administrative assistant, who attested that there were no unusual occurrences or events and that the patient did not seem upset upon leaving the office that day.

As for the committee’s decision, the review board found that it showed a coherent and rational connection between the relevant facts, the outcome, and the reasoning process leading to that outcome.

The decision was transparent, intelligible, and justified as a whole, the review board said. The decision addressed the concerns raised, explained the factors considered, and gave detailed references to the information in the record that supported the committee’s conclusions.

The review board acknowledged the patient’s firmly held belief. However, it considered the information in the record and found it consistent with the committee’s conclusions. The committee was responsive to the patient’s concerns when it noted its expectations for physicians, the review board added.

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