Importance of personal support persons in the exam room

Accommodate patients’ requests to have a relative, friend, or other personal support person (e.g., religious and spiritual counselor/advisor) present during the exam.[1]  An exception would be if responders consider the request to be potentially harmful to the patient or the exam process.[2] Patients’ requests not to have certain individuals present in the room should also be respected (e.g., adolescents may not want their parents present). Examiners should get explicit consent from patients to go forward with the exam with another person present. When others are present, appropriately drape patients and position additional persons. (It is also important to inform patients of confidentiality considerations regarding the presence of support persons during the medical forensic history. For a discussion of this topic, see C.4. The Medical Forensic History.) 
 
Strive to limit the number of persons (beyond the patient, examiner, advocate, personal support person, and any necessary interpreters) in the exam room during the exam.  The primary reason is to protect patients’ privacy, but also because exam rooms often cannot accommodate more than a few individuals. Law enforcement representatives should not be present during the exam. When additional health care personnel are needed for consultation (e.g., a surgeon), patients’ permission should be sought prior to their admittance. In cases in which examiners are supervising an examiner-in-training/licensed health care student, patients’ consent should be obtained prior to the student’s admittance to examine patients or observe the exam. It is inappropriate to ask patients to allow a group or nonlicensed medical students to view the exam. 


[1] Paragraph partially drawn from the California Medical Protocol for Examination of Sexual Assault and Child Sexual Abuse Victims, 2001, p. 15.
[2] For example, in cases involving adolescents or vulnerable adults, caretakers should not be allowed in the exam room if they are suspected of committing the assault or of being otherwise abusive to the patient.


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