Professionalism in the intimate examination: How healthcare practitioners feel about having chaperones present during an intimate consultation and examination

Background. Despite the clear prohibition against sexual relations with one’s patients, complaints of a sexual nature against practitionersregistered with the Health Professions Council of South Africa (HPCSA) have been increasing. The HPCSA does not provide ethical guidelines regarding the use of a chaperone during intimate examinations.Aims. (i) To ascertain how a group of medical practitioners felt about the presence of chaperones during the consultation and intimate examination of patients; (ii) to determine whether they currently engage the services of chaperones; (iii) to assess how they felt about consensual sexual relationships between medical practitioners and their patients.Methods. A self-administered, questionnaire-based survey was distributed to gynaecologists and medical practitioners.Results. There was a 43% response rate with 72% of practitioners in favour of using a chaperone during an intimate examination, although only 27% always do so. Most practitioners felt that consensual sexual relationships with patients are unacceptable; 83% felt that ethical guidelines on this topic were needed.Conclusion. The HPCSA should develop guidelines on the use of chaperones to assist practitioners. With medical litigation increasing,using chaperones will benefit patients and practitioners

The ‘war on drugs’ has failed: Is decriminalisation of drug use a solution to the problem in South Africa?

This article engages in the debate surrounding decriminalisation of drug use and whether this is a possible solution to the problem of druguse in South Africa – a question becoming more prevalent in global discussions about drug policy and its efficacy. We argue that two aspects must be addressed when evaluating a policy: its philosophical justification and its efficacy. We find that criminalising drugs may be justified by the public harm principle, but it does not effectively achieve the purpose of preventing and decreasing drug use and associated burdens. Thus, we argue that prohibition is a constitutional limitation, but does not necessarily achieve its purpose in the least repressive or most effective way. Finally, we suggest that a solution to the drug problem will have to address the health needs of the drug user and the context, particularlysocio-economic, of drug use. Decriminalisation could theoretically do this by changing society’s perception of drug users, thus helping to promote a human rights-based, public health-orientated approach to the drug problem in South Africa

Professionalism and the intimate examination – are chaperones the answer?

Complaints of sexual impropriety against health care practitioners are escalating. Professionalism in the practitioner-patient relationship and the role-based trust in health care do not allow crossing of sexual boundaries. Communication with patients is key to prevent erroneous allegations of sexual misconduct. The intimate examination is difficult to define. A chaperone present during an intimate examination protects the patient and practitioner and should be considered a risk reduction strategy in practice.S Afr Med J 2011;110:814-816

Extragenital Müllerian adenosarcoma with pouch of Douglas location

Background: Of all female genital tract tumors, 1-3% are stromal malignancies. In 8-10% of cases, these are represented by Mullerian adenosarcoma an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. Variant that arises in the pouch of Douglas is scarcely mentioned in the medical literature.Case Presentation: A 49-year-old para-0 woman, was seen at our OB/GYN-UNIT because she complained vaguely of pelvic pain. She had a mass of undefined nature in the pouch of Douglas. A simple excision of the mass showed low-grade Mullerian adenosarcoma with areas of stromal overgrowth. One and a half year after surgery, at another hospital, a mass was detected in the patient's posterior vaginal fornix and removed surgically. Six months later she came back to our observation with vaginal bleeding and mass in the vaginal fornix. We performed radical surgery. The pathological examination showed recurrent adenosarcoma. Surgical treatment was supplemented by radiation therapy.Conclusions: The case of Mullerian adenosarcoma reported here is the third known so far in the literature that was located in the pouch of Douglas. To date, only two other such cases have been reported, including one resulting from neoplastic degeneration of an endometriotic cyst