Friday, September 5, 2014

Sexual Abuse by Physicians: More common than we think...

Around 25 percent of the physicians in the United States face malpractice charges every year, including sexual misconduct. Psychiatrists, who make up only six percent of all doctors, account for 33 percent of all the sexual abuse claims.

The vast majority of physicians in the United States do not commit or condone sexual violence; however, perpetrators exist in every profession and the true prevalence of sexual assault committed by physicians against their patients is difficult to discern due to:

  •  Self-reporting by physicians themselves, or from reports by fellow physicians. Due to the obvious professional/career ramifications of self-reporting, the actual prevalence of sexual assault by physicians may be higher than indicated by the available data ; and
  • Victims of sexual assault by their physicians are thought to be even less likely to report the assault than victims of assault by other individuals, due to multiple factors. A low reporting rate further indicates that the prevalence of sexual assault by physicians may be higher than what is known.
A 1998 study in the Journal of the American Medical Association1 found:
  • The number of physicians disciplined per year for sex-related offenses increased from 42 in 1989 to 147 in 1996; and the proportion of all disciplinary orders that were sex related increased from 2.1% in 1989 to 4.4% in 1996.
  • Discipline for sex-related offenses was significantly more severe than for non-sex-related offenses, with 71.9% of sex-related actions involving revocation, surrender or suspension of medical license.
  • Of 761 physicians disciplined, 75% of the incidents involved patients, including sexual intercourse, rape, sexual molestation, and sexual favors in exchange for drugs 
  • As of March 1997, 39.9% of physicians disciplined for sex-related offenses between 1989 and 1994 were still licensed to practice
  • Physicians disciplined for sex-related offenses were more likely to practice in the specialties of psychiatry, child psychiatry, obstetrics and gynecology, and family and general practice.

The Dynamics of Sexual Abuse by Physicians:

As with all forms of such violence, sexual assault or abuse perpetrated by physicians against their patients is a malicious abuse of power intended to harm, control, and/or manipulate the victim. The physician-patient relationship is unique in ways that encourage an abuse of power by physicians who have malicious intent:
  • Physicians possess knowledge and expertise that the patient does not have, but needs. 
  • Patients are forced to trust physicians to diagnose and treat them appropriately and ethically. 
  • Patients are often at their most vulnerable when interacting with physicians, because of physical pain, injury, illness, disease, mental/emotional distress, or other very personal or intimate problems. 
  • Many patients must undress, be put under anesthesia, or otherwise placed in a position of powerlessness or incapacitation when being examined or treated by a physician.
Some of the ways offending physicians may commit and conceal sexual assault of their patients: 

  • Assault patients while they are unconscious/incapacitated, and thus unaware of the assault.
  • Tell patients that the behavior is a normal part of the examination or treatment.
  • Manipulate patients into thinking that their questions or concerns about the abusive behavior are without merit, are confused, or are just a misunderstanding. 
  • Convince the patient that no other physician can effectively treat them. 
  • Threaten to discontinue treatment if the patient refuses to be subject to abusive exams or procedures. 
  • Alter treatment (particularly medications) to keep the patient in need and/or compliant. 
  • Threaten to discontinue treatment if the patient reports the abuse.
  • Silence the patient by giving him/her money, gifts, or access to prescription drugs/opioids.  
  • Convince parents or loved ones of patients that they are trustworthy; or silence loved ones with money, gifts, or access to drugs. 
  • Elicit public support from patients they have not abused, and others who believe them incapable of sexual violence.

Sexual Abuse Harms Victims Forever.

Sexual assault has psychological, emotional, and/or physical effects that can last from a few weeks to forever. Victims suffer from depression, suicidal ideation and behavior and post-traumatic stress disorder.

Also, and because of their humiliation, they will probably avoid healthcare in the future. Nurse practitioners and doctors need to be sensitive to all patient’s need for modesty and bear in mind a possible background of sexual abuse.

Gowns or underwear shouldn’t be taken off without patient’s consent. Students don’t have the right to perform non-consensual exams on unconscious patients. Pelvic exams and pap smears are not necessary for birth control prescriptions. Doctors don’t need to ask their female patients to take their shirt off to listen to their hearts.

The Solution

Protecting the safety of the patient should be the first and foremost concern of healthcare. This includes protecting patients from sexual abuse by providers.

The only solution to prevent sexual abuse by healthcare providers is for patients to be able to refuse any intimate exam or procedure without without penalty. 

Any attempts to withhold prescriptions or treatments, dismissal of the patient from the practice, guilting, shaming, or other intimidation, at the refusal of an intimate exam/procedure or the request to undress should be seen as coercion and a pattern of sexual abuse.

This will also protect providers from false allegations.

There are very few (if any) situations where the results of an intimate cannot be obtained by other means:

  • Pelvic exams are not required for birth control. 
  • An enlarged or high riding prostate can be detected by ultrasound.
  • A good physician exam can conduct a physical exam on a patient wearing a bathing suit. 
  • A physician pediatrician who insists on viewing a patient's genitals without compromise should be suspect.
  • A physician who withholds treatment or prescriptions, or dismisses patients should be reported to the police so patterns of abuse can be established. 

Chaperones are not the solution. Many abuses have been conducted in the presence of other medical personnel. Above all else, the patient's wishes should be respected.

If a patient refuses a chaperone in a situation where one is required (either by law or by policy) should omit that portion of the exam or procedure without penalty to the patient. 


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