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Routine practice
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Information about provider gender is included with other information routinely sent to women on booking.
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Open clear communication about provider gender issues should be provided as early as possible in each woman's episode of care to create realistic expectations and avoid disappointments.
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NB. "Female doctor preferred" stickers on the patient medical records are uninformative, have no status and should be removed and/or disregarded.
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Women making such requests for a female health care provider, will be provided with an information sheet about provider gender issues. This applies whenever they make the request - Consumer fact sheet: When you want to see a female doctor.
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Referral pathway
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Summarises the response and referral pathway for women making requests for particular providers -Referral pathway (algorithm)
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Counselling of women / partners
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- Women requesting female health care providers are to be counselled on this issue by midwifery staff.
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- This will normally be arranged through the triage process for antenatal and gynaecology bookings and occur prior to the first medical consultation.
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- This discussion is intended to ensure the woman's needs and concerns are understood and that her expectations of care are realistic.
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- It should be recorded in the medical record with a stamp for future reference.
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Counselling
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This will include that choice of provider gender cannot be offered in:
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- specialised or urgent circumstances
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It is therefore expected that when all women have experienced this booking / counselling process, it will be unusual for a woman to arrive in such areas with unrealistic expectations.
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Elective appointments
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A small number of elective appointments (2-3 per female doctor) will be reserved, when available, for women who are prepared to book ahead to see a female doctor.
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Alternative models of care
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- Midwife Antenatal Care: An option for women without obstetric complications.
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- Well Women's Service. Staffed by midwives (most of whom are female).
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- Pap smears (women without symptoms).
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- Women's Health Assessment Clinic. Health assessment by nurse practitioner.
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- Referred as appropriate to the Women's or other services.
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NB. If symptoms or complications develop, care will need to be provided by the most appropriate rostered staff.
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Specific requests
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Discussion may assist understanding of the woman's request to be seen by a female health care provider.
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The request may be based on:
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- gender generalisations (e.g. beliefs that women doctors are more sensitive)
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A reasonable expectation that her concerns will be listened to by the provider she sees is likely to help.
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Request received on the day of appointment
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If a request is received on the day of an appointment the woman will be asked to discuss the request with the triage staff.
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Options:
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- continue with her appointment as booked
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- or re-book if deemed appropriate by the triage staff
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Patients will not be transferred to female doctors without discussion with the triage nurse/ midwife and/or medical staff concerned.
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Refusal of vaginal examination
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If a woman is not prepared to have a vaginal examination, performed by the allocated doctor, it is not appropriate or best practice for the examination to be performed by a doctor not involved in the full consultation:
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- it may be necessary to make a further appointment for full assessment
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- woman may refuse examination (right to refuse care is acknowledged)
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Acute or urgent situations
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If a request is received in an acute or urgent situation, especially the
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the woman should be advised that such requests cannot normally be met.
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It is not appropriate to second a health care provider away from rostered duties for an examination, consultation or procedure that could be attended to equally well by the allocated health care provider.
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A woman always has the right to refuse care offered, and such refusal should be fully informed.
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The senior registrar on duty should be advised if such refusal occurs.
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- Senior Registrar may (exceptional circumstances) request another health care provider to see the woman.
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- Senior Registrar may contact on-call consultant for advice.
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Exceptional circumstances
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In exceptional circumstances, if a clinician believes care will be significantly compromised as a result of refusal to accept care by a particular clinician, the senior registrar on duty must consider the relative risks of refusing the request in accordance with this policy, and the consequences of calling another health care provider away from his or her rostered duties.
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If necessary, the consultant on call should be involved in this decision-making.
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This policy does not preclude senior staff of the relevant discipline from deciding on clinical grounds to accommodate a particular request, if a suitable clinician is reasonably available and willing to do so, without unreasonably compromising the care of other women.
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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Please remember to read our disclaimer.
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