I saw a woman the other day who complained of painful blisters in her ears, around her mouth and up her nose. After listening to her story I moved forward in my chair in order to examine her, and entered her personal space. “I don't want you to look up my nose”, she said. I raised an eyebrow and she continued “I have a thing about blowing my nose in public”. We talked for a little longer and I gave out non-verbal cues that said “it's only little old me, you don't really mind do you?” But she did. It was very tempting, as I got close to her to examine her ears and mouth, to bend down and have a quick peek. But just as gentlemen do not look up ladies' skirts, so they also ought not to look up their noses without permission.
I thought that she was suffering from cold sores, and so it wasn't essential for me to examine inside her nose. But it made me think about the nature of consent. I quite often do simple examinations without explicitly asking consent. I might come up close to look at a skin lesion, or take the patient's pulse as I talk to them. Sometimes I forget to ask permission to take the blood pressure, and find myself wrapping the cuff around the patient's arm as we continue to talk. In these situations moving from talking to examination seems to flow naturally, and the patient indicates their consent by not objecting. Presumably the patient was aware that doctors often do this sort of thing, which was why she felt it necessary to give me advance warning that she did not consent. I wondered whether sneaking a peek up her nose would constitute an assault, and I preferred not to risk it.