Indicator 10: The Curtain That Counts: Patient Privacy During Consultation and Examination

Series: Understanding MSDS | Post 13 of 52
Standard 3 (ROM-3) | Indicator 10 | Category: RED (100% required)

The Door That Stayed Open

Dr. Zubair Hussain had practised general medicine in Sahiwal for fifteen years. His clinic was one long room above a market: a table near the window, a bench along one wall, and an examination couch in the far corner.

The couch had no curtain. The door to the stairwell was usually left open for air.

On the morning of the PHC assessment, a young woman came in with lower abdominal pain. Her husband stayed on the bench outside with their son. Dr. Zubair asked her to lie on the couch and began palpating her abdomen. Two men waiting for their turn were sitting on the bench inside the same room. The door was open. Nobody else was beside the couch.

The assessor did not interrupt. He waited until the patient left, then asked two questions.

“Doctor sahib, where is the screen for the examination couch? And who stays with a female patient while you examine her?”

Dr. Zubair had no answer to either. He had simply never looked at the room through a patient’s eyes.

Indicator 10 is a RED indicator. It was scored as not met.

What Indicator 10 Requires

The indicator reads: Clinic has adequate arrangements for the privacy of patients during consultation/examination.

The surveyor observes whether arrangements for the privacy of patients during consultation and examination are in place, and whether that privacy is actually respected.

The manual states that the privacy of all patients during history taking and examination is very important and cannot be ignored. It sets out the following expectations:

• Female patients and minors are not examined alone by male practitioners
• In such cases, the accompanying attendant, preferably a female, should be requested to remain present
• Partitioning of the waiting area for male and female patients and attendants, with a cloth curtain, a wooden wall or a tinted glass wall, is strongly recommended within the available space and budget

The manual refers practitioners to the PMDC Code of Ethics for Medical and Dental Practitioners and the PHC Charter for Patients for further detail. The Patient Charter gives every patient the right to be treated in privacy and with dignity.

How It Is Scored

There is no partial credit.

If the clinic has arrangements for the privacy of patients as described, the indicator is scored as fully met. If privacy arrangements are not available, it is scored as not met.

The assessor looks at the physical arrangement and at what actually happens during a consultation. A curtain that is never drawn protects nobody.

Why the Commission Cares

Privacy is not a courtesy added to care. It is part of care. A patient who feels watched will not describe her symptoms fully, will refuse an examination she needs, or will not come back at all. In many families in Punjab, a woman’s consent to be examined depends on the trust that the room is closed and a chaperone is present.

The requirement also protects the doctor. A female attendant beside the couch is a witness to a proper examination. Without one, a misunderstanding can quickly become a complaint.

What Dr. Zubair Changed

A ceiling track with a washable, light coloured cloth curtain was fixed around the examination couch. The cost was under four thousand rupees. The bench was moved outside the consultation area, and a wooden partition now separates the waiting space from the room where he examines.

The waiting area itself was divided with a curtain, one side for female patients and attendants and the other for men.

He hired Shazia, a young woman from the neighbourhood, as a clinic assistant. Her duties were written in plain terms: whenever a female patient or a child is examined, she stays beside the couch unless the patient’s own female attendant is present. The door is closed during every examination.

At reassessment, the assessor watched a consultation from start to finish and scored Indicator 10 as fully met.

“I thought privacy meant keeping records secret,” Dr. Zubair said later. “It begins much earlier, with a curtain and a closed door.”

A Quick Self-Check

• Is there a curtain or screen around your examination couch, and is it drawn every time?
• Is the door closed during history taking and examination?
• Can waiting patients see or hear what happens in the consultation area?
• If you are a male practitioner, is a female attendant or staff member present whenever you examine a female patient or a minor?
• Is the waiting area partitioned for male and female patients and attendants, as far as space allows?

Series so far: Post 1, The Inspector | Post 2, 18 Standards, 47 Indicators | Post 3, Red, Yellow and the Score | Post 4, Signboard | Post 5, Easy Access | Post 6, PHC License | Post 7, Door Plate | Post 8, Consultation Hours | Post 9, Qualified Manager | Post 10, PMDC Certificate | Post 11, Minimum Premises | Post 12, Comfort Facilities | Post 13, Patient Privacy

About this series: Educational content on MSDS compliance for clinics under the Punjab Healthcare Commission, based on the PHC MSDS Reference Manual 2017.