Health: A sore throat? Then kindly remove your blouse and bra, please

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The Independent Online
I've been much troubled by Tubes lately. I'm not talking hollow cylinders, or the wild American band that gave us "White punks on dope". No, my Tubes are far more unsettling. They're an acronym, courtesy of a group of medical students, for Totally Unnecessary Breast Examinations.

Now, a lot of medical examinations are of dubious necessity. We used to stick a finger up the backside of anyone who might have appendicitis, until someone pointed out that it was very uncomfortable and of no help in making the diagnosis. Nurses used to, and some probably still do, take half-hourly blood pressures from anyone who happens to be occupying a bed, again for no scientific reason.

These infringements are misguided rather than abusive, a reflection of protocols and procedures that had been taught many years ago and never updated. But the thought of a group of male students contriving to perform breast examinations in the knowledge that they are unnecessary, and to devise an acronym to celebrate their achievement, is in a different league.

To be fair, I'd never heard of the acronym before, and I'd never heard medical students use it, until Natasha from the Trust Me, I'm a Doctor research team unearthed it in a doctors' mess.

However, the taboo of doctors finding patients sexually attractive, and gratifying their desires through the physical examination, is not much talked about at medical school. No one wants to tackle the subject full on. An 18-year-old student bursting with testosterone encounters an incredibly attractive patient. Can he switch off his sex drive, just like that?

One answer came from a brave medic writing in a student journal.

"A 19-year-old woman was admitted to hospital for cystoscopy to investigate the possible causes of a series of urinary tract infections. I immediately noticed that she was very attractive. I began clerking but got nowhere, as I found myself staring into a pair of inviting blue eyes. The patient appeared to have developed an affection for me. As I plugged away with totally inane questions, I realised how devious I could be. I ran through a list of differential diagnoses trying to find one that would require me to examine her ample breasts that were being shoved towards me ..."

To his credit, the student bolted before following through with the assault, but was clearly affected by it ("you probably think I'm a worthless lump of hormone") and sought solace in the library.

A Dutch study found that more than half their doctors thought sexual feelings towards patients were acceptable, and 4 per cent admitted to actual sexual contact. In Britain, as you'd expect, the admission figures are lower. The GMC forbids it, and we just don't talk about it.

A breast surgeon did, however, describe his three switches to me. "One is as a man, who finds women sexually attractive; one is as a surgeon, who wants to remove a cancer for good, and one is as an artist who respects the female form and wants to achieve the best cosmetic result possible. Whenever you put on your white coat, think 'have I got my switches right?' If not, relieve yourself."

Fortunately, I've never needed to, but I was grateful for the advice. Most students get none and, as all doctors do, they displace awkward emotions into black humour and another acronym is born (Remember TF Bundy? - Totally Fucked But Unfortunately Not Dead Yet). But how often do acronymous attitudes become real behaviours?

To my horror, the Trust Me researchers found that the female perception of a male doctor examining their breasts unnecessarily is not unusual. Young women spoke of having their breasts examined without explanation when they'd gone in with a sore throat, a prescription for the Pill, for a new patient registration or even a school medical.

Not only did it cause lasting anxiety, but breast specialists agreed that such routine or opportunistic examinations are clinically unnecessary.

So what can you do to prevent Tubes? No one's ever shoved ample breasts in my direction, and I suspect (or, at least, hope) that the number of patients and doctors who get sexual gratification from consultations is small. Many patients have entirely trusting relationships with their GP and are happy to let the doctor decide whether an examination is necessary.

However, there is no diagnostic value in breast examinations as a "while you're here, let's do it" screening procedure or as a routine check (except for HRT, but even this is disputed). Some patients and doctors may be reassured by it, but if you don't want one, decline.

For specific breast problems or symptoms that may be related to breast disease (eg bone pain) then an examination may well be justified, but the onus is still on the doctor to convince you of the relevance and gain your consent. Otherwise, it's assault.