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Article Excerpt
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In 2005 (the most recent year for which data was available), 963.6 million visits were made to physicians throughout the United Sates (Cherry, Woodwell, & Rechtsteiner, 2007). This is the equivalent of 331 visits per 100 persons per year. Among medical specialties, psychiatrists were the 8th most frequently visited physician for a total of 28,125,000 visits, or 9.7 per 100 persons per year. Of these, 18.3% were referrals from other physicians and 53.5% were from nonphysicians.
Certainly all psychotherapists have clients who have seen, or are seeing, one type of physician or another for evaluation or treatment. Unfortunately, as with other disciplines within the helping professions, some physicians cross sexual boundaries with their patients. In fact, the issue of sexual misconduct by health-care providers dates at least as far back as the Hippocratic Oath, which directly cautions physicians against sexual relations with patients of either sex.
The Nature of the Problem
In 1991, after reviewing the problem of physician sexual misconduct, the Council on Ethical and Judicial Affairs for the American Medical Association (AMA) concluded that it is unethical for a physician to have a romantic relationship or sexual contact with a current patient. Such a relationship with a former patient is also considered unethical if the physician "uses or exploits trust, knowledge, emotions, or influence" derived from the prior physician-patient relationship. The Council also recommended that when a physician learns of a colleague's sexual misconduct, they must report it to "the local medical society, the state licensing board, or other appropriate authorities," unless doing so is not in the best welfare of the patient. Finally, the Council concluded that all medical training should include education on the topics of "sexual attraction to patients and sexual misconduct."
On the most basic level, "sexual misconduct" includes any behavior that sexually exploits the physician-patient relationship (FSMB, 1994, 2006). Such misconduct can be verbal or non-verbal, overt or covert behavior that does not serve a diagnostic or therapeutic purpose. The Council on Ethical and Judicial Affairs for the American Medical Association has identified two general categories of sexual misconduct: "sexual improprieties" and "sexual violations" (AMA, 1994). These categories vary by the degree of "severity" of the sexual act, and they range from physician-patient sex (whether initiated by the patient or physician) to any conduct that may be reasonably interpreted by the "average" patient as being sexual in nature.
According to the Federation of State Medical Boards (FSMB), "sexual improprieties" include, but are not limited to:
1. Conducting an "intimate" physical examination or treatment without clinical justification.
2. Conducting an "intimate" examination without explaining the purpose or need for such and without obtaining informed consent.
3. Conducting an "intimate" examination in the presence of medical students (or others) without obtaining the patient's informed consent, or continuing the exam when consent was withdrawn.
4. Touching a patient's genitals (in particular, "mucosal areas") without wearing gloves.
5. Failing to provide and allow a patient privacy when undressing.
6. Failing to ensure a patient's privacy through proper draping procedures.
7. Requesting details of a patient's sexual history or "likes and dislikes" when such questioning is not indicated given the nature of the examination.
Unlike "sexual violations," which are more "generic" sexually abusive or assaultive acts, "sexual improprieties" are offenses that may be unique to medical professionals.
As identified by the FSMB, "sexual violations" include sexual intercourse; genital-to-genital contact; oral-genital contact; oral- or genital-to-anal contact; contact with any "private" part of the patient's body for any purpose other than examination or treatment; and romantic or "sexualized" kissing. Patient masturbation, whether performed by the physician or the patient (as the result of the physician's encouragement), is considered a "sexual violation," as is exchanging "practice-related" services for sexual acts.
The Scope of the Problem
As with other helping professions, it is difficult to determine the actual incidence of physician sexual misconduct. This is because many incidents are never reported, some are resolved without any formal record, and others may be included under a more general complaint (such as "negligence"). The FSMB reported that across 42 states from 1990 to 1993, a respective 2.6%, 3.6%, and 3.9% of reported violations involved sexual misconduct (Winn, 1993). By 1996, that figure had risen again, to 4.4% (Dehlendorf & Wolfe, 1998). In an 18-month period...
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