The allegation that a gynaecologist raped his patient at the Victoria Jubilee Hospital have triggered concerns that the trust accorded doctors has been sullied and a debate over how medical professionals should behave to protect themselves against such claims.

Arising out of the scandal that has rocked a profession long held in the highest esteem, the Medical Council of Jamaica (MCJ) itself is recommending that doctors, for their own good and that of their patients, be chaperoned whenever they have to do internal examinations involving high levels of intimacy.

“It is recommended that a third party should be in the room when a patient is going to have an internal exam,” said Dr Trevor McCartney, chairman of the Medical Council. “Doctors are exposed to allegations and improprieties, which become difficult to defend if a third party is not present during an examination.”

“There is no doubt that profession feels quite wounded and disgraced. It is quite clear from the investigations that this was a very unsavoury episode that comes through system failure,” president of the Medical Association of Jamaica (MAJ), Dr John Hall said in an interview with the Sunday Observer.

Hall suggested that had the accused doctor been chaperoned at the time he examined the patient, the allegations would not have arisen.

Dr Matt Myrie, a senior gynaecologist at the Victoria Jubilee Hospital is now in court over accusations that he raped a woman in the hospital’s ultra-sound unit. A nurse, Janet Spence has also been charged with attempting to bribe the woman to drop the allegations against the doctor.

Since then, the incident has turned the spotlight on the issue of trust between professional service providers like doctors, dentists, physiotherapists, masseurs, and the like – whose work include intimate body contact – and their patients/clients.

Even if the allegations againt Myrie proved to be unfounded, it would have caused damage to the profession, said Trelawny medical doctor, Patrick Harris who has practised for over 20 years and seen hundreds of patients at his Duke Street office in Falmouth, the capital.

“And if it is proven to be not true, it would have a double negative impact,” said Harris, who is also the member of parliament for North Trelawny.

McCartney said he didn’t think that the case would damage the trust between doctors and patients, arguing that “a lot of people will see it as an isolated case”. But he said doctors were going to have to change their modus operandi in terms of the way in which they examine patients, “in order to protect both doctor and patient”.

The Medical Council head admitted that there was no rule stipulating that a third party, for example a nurse, should be present when a doctor was examining a patient, but the Council “recommends that a third party be present”.

However, he said there were downsides to the suggestion that a third party be always present and he was doubtful it could work in the present situation in the public hospitals, given the severe shortage of nurses.

“To take one nurse out of an active area is going to mean a tremendous reduction in patients seen and the service that is given,” he said. “There have been many occasions where one nurse was taking care of a ward of 40 patients. And this nurse has to administer medicine as well as perform medical procedures on these patients.”

“For a nurse to be present in an examination room every time, something would have to give,” McCartney said.

He was also concerned that introduction of a third party would “retard the information that the patient will give the doctor and the patient won’t want to confide in the doctor which is going to cause a problem”.

Nonetheless, he added, if patients felt any form of discomfort, they had the right to request a third party’s presence – whether it is a nurse or a relative – during an examination.

MAJ’s Dr John Hall said he was prepared to wait to to see how the Myrie case panned out in court before taking a position, but agreed the 70 per cent shortage in the cadre of nurses required to service the island’s hospital, would pose challenges to the idea of a third party presence.

In the meantime, Hall said the association would be standing by Myrie. “As wounded and disgraced as we feel by the incident, we won’t abandon our colleague. We will assist in whatever meaningful way we can, but we are not covering up anything,” he explained. “Our primary responsibility is to the patient and we don’t compromise that in any way.”

President of the Jamaica Dentist Association, Dr Dawn Lawson-Myers also did not believe the case would seriously affect the level of trust Jamaicans have for medical professionals.

“If it has, I don’t think that it is to a great degree. We now live in an age where we realise that people who are traditionally seen as having high morals, sometimes it is not so,” she said.

Lawson-Myers said that in the dentistry profession, a third party was usually recommended to be present when sedation was required during a procedure “because persons coming out of sedation sometimes experience hallucination”.

“I think it will make a very small, if any, impact in terms of confidentiality or confidence level of patients,” Dr Arthur Green, district medical officer for St Ann agreed.

Green said the current allegations of sexual misconduct would not seriously harm. But to prevent future mishaps, he, too, suggested the use of chaperones.

“This can be pre-empted by using chaperones when they are attending to clients so that you wipe out any type of doubts that may occur,” Dr Green said. “That is one of the very easy methods of dealing with it.”

Raphael Royal, a physiotherapist and physical trainer with a clientele of mostly executives, believed the incident would soon be forgotten, as it was an isolated one.

“No, I don’t think it (the incident) will affect patient’s trust in a doctor because people know their doctors and there is a tradition of trust,” he said. “However, people are going to be more aware and it is going to be in the back of their minds.”

Royal who runs the popular Raphael’s Gym and Therapy Studio and is a devout Christian, agreed that henceforth professionals, like himself, would have to ensure that trust and privacy were the driving force behind their profession.

On the other side of the debate, head of the West Indian chapter of the American College of Obstetrics and Gynaecology (ACOG), Dr Horace Fletcher said not only had the incident sullied the medical profession, but it had also muddled the doctor-patient relationship.

“It has tarnished the profession and caused a mistrust between patients and physicians,” he said. “If a patient goes to a physician they are expecting that there will be a level of trust. This incident is going to cast a doubt in the patient’s mind.

“What we should be doing is that every single internal patient should have a chaperone. It protects both the patient and the doctor,” said Fletcher. Harris argued that every time an allegation like that against Myrie was made, “it will damage the trust that the society has in the profession”.

” Doctors are traditionally persons who people look up to in the society, so we are not supposed to have any kind of incident like those,” he added.

“If the people can’t trust their care-givers, ministers of religion and politicians, it just does not go,” he told the newspaper.

Harris also recommended that a male doctor should never examine a female patient without a chaperone, in an effort to prevent allegations of sexual misconduct. “Anybody who tells me that they don’t need a chaperone, right away I know that they need a chaperone and so if they don’t want that kind of protection, I know I need that protection,” he added.

“Maybe we should get to the point where this needs to be enforced,” he argued. “These are really things that we should look at.”

Like Harris, prominent Montego Bay dentist, Dr Dean Weatherley said he had never seen a patient without the presence of his assistant during his more than 15 years in dental practice.

“I have never seen a patient without my assistant being around and I will never do that,” he stressed, adding that someone is always there with him during the presence of a patient.

“I put this measure in place so as to prevent people from ‘setting me up’, because people will try to do it,” Weatherly said

The Montego Bay dentist who is also a successful football coach, believes that allegations of sexual misconduct against persons in the medical profession can have a far-reaching effect on the profession.

“When these allegations arise it can have far- reaching effect because the trust that the patient has in the doctors will be very hard to regain,” he said.

With additional reporting by Mark Cummings in Montego Bay and Carl Gilchrist in Ocho Rios