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©New
Straits Times (Used by permission)
by Annie Freeda Cruez
KUALA LUMPUR: Be professional and keep strictly to established procedures. This
is the advice of Director-General of Health Tan Sri Dr Ismail Merican to doctors
examining patients claiming sexual abuse, including rape and sodomy.
Doctors should not be influenced by any other factors,
including political inclinations or pressure from higher authorities.
"All findings by a practitioner have to be based on solid evidence which can
stand up to legal scrutiny and examination, as and when is necessary, hence
leaving no avenues for errors or cover-ups," he said in a press statement.
"It is not the role of the examining practitioner to determine whether the
incident was consensual or not. Absence of physical findings in alleged victims
of serious sexual assault do not necessarily indicate abuse has not taken
place."
He said the absence of general injuries may arise from submission of the victim
because of emotional manipulation, fear of violence or death, or verbal threats
received.
The force used, or the resistance offered, may have been
insufficient to produce injury.
Also, bruises may not become apparent even after 48 hours following an assault.
Dr Ismail added that a delay in reporting sexual abuse would allow minor
injuries to fade or heal.
He also said the victim's previous sexual experience, the natural elasticity of
the anus, the use of lubricants and the natural elasticity of post-pubertal
female genitalia, including the hymen, could explain the absence of general
injuries.
He said the ministry only allowed doctors with the required clinical experience
and expertise to handle cases of alleged sexual abuse.
"Having said that, I would like to stress that one cannot be absolutely certain
that sexual abuse or otherwise has taken place simply based on preliminary
physical examination findings.
"No lay person should also make his or her own interpretation of what may have
happened simply by looking at the medical records, without being given the
benefit of the circumstances and other important information that only the
examining medical practitioner may be privy to."
He said the ministry was aware of the circulation of a flyer alleging that a
certain complainant was not sodomised, based entirely on physical examination
findings from a medical record released on the Internet by unscrupulous
individual(s).
Dr Ismail advised the public to refrain from drawing any conclusions from the
medical records alone.
He said the circulation of any medical report was in breach of patient
confidentiality and was liable to be used for reasons unacceptable to the
medical profession.
Among others, the established procedures doctors examining a possible sexual
abuse victim should take note of are:
- a detailed history of the alleged incident;
- a full physical examination of the patient for signs of
injury, which may co-relate with the history of how and what kind of force was
used, if any;
- a complete physical examination of the whole body, with
special emphasis on private parts or genitalia for evidence of injury or trauma;
and,
- the collection of appropriate bodily samples/specimens for
forensic analysis.
"The medical practitioner needs to piece together the jigsaw from the history,
the physical findings and the forensic reports to arrive at the most probable
diagnosis.
"As part of good medical practice, the diagnosis should include the nature of
the condition, its seriousness and the causal factor."
Dr Ismail stressed that any dereliction in carrying out these procedures
strictly may result in an incomplete physical examination, giving rise to a
false conclusion that the alleged victim had not been abused.
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Circular No 304/2008
