Warning: Parts of this post are NSFW (Not Safe For Work): It contains nudity and sarcasm.
It is funny how things connect in this world. The 2012 movie Cloud Atlas (Starring Tom Hanks, Halle Berry, Hugh Grant) is a good example of how things connect.
"An exploration of how the actions of individual lives impact one another in the past, present and future, as one soul is shaped from a killer into a hero, and an act of kindness ripples across centuries to inspire a revolution. (Source: IMDB)"
So goes it with this "military theme" has grown the same way. It started with a book titled "Medical Rape," by Lars G Petersson. (You can download it as a FREE ebook here:) I have been having on going conversations with Lars, I introduced him on my blog here: Lars will be writing a future post for my blog too.
My next post: "From Mother Theresa to Dr. Mengele" dealt with examining how physicians enter medical school wanting to help and leave (quite frankly) as monsters. It looked at the Holocaust as the greatest example of physicians' betrayal of their "do no harm" oath and how this occurred.
In the process of doing research on patient dignity/healthcare abuses, I came across some interesting information about "The Medical Process for Candidates Applying for Entry into the Australian Defence Force." I referenced this in a comment on the Bioethics Discussion blog of Dr. Maurice Bernstein. Looking at my comment I realized that this would make a great post on my blog.
I began to see a pattern. Lars Petersson's book "has been written for all the men who have suffered as a result of abusive medical examinations by military institutions and their civilian associates." The focus of the book is on the "musterung" (the German military medical induction exam).
"From being a perverted male-only ritual of 'initiation', the whole matter, the musterung (the military medical induction exam), in the name of so called 'equal rights' between the genders, has developed into nothing but a state-approved sexual humiliation process of young men. Today female medical inspectors, though themselves under no legal obligations neither to serve or to strip, have almost completely taken over the dominant roles in this age old humiliation process. Today these women have grabbed for themselves what could look like almost unlimited power over thousands of legally forced, naked young men."
So here is the post I made from my comments on Bioethics Discussion:
Here is a perfect example of the double standard that men face:
Why is a Medical Examination required?Medical standards in the ADF need to be of the highest level to allow the successful completion of all military duties. These are often performed in isolated and stressful circumstances where there is no ready access to medical care.
The medical process will assess your suitability to perform military specific duties, and your ability to adapt to different living conditions. The medical process aims to ensure that you do not have a pre-existing medical condition requiring uninterrupted access to medication, medical care or special diets.
OK, fair enough. Here are the other section headings...
What are the processes of the Medical screening?
Your Opportunities Unlimited (YOU) Session"Unlimited Opportunities," that must be a good thing...
What is involved in the Preliminary Examinations?
What is involved in the Medical Examination? Now it gets good....
...During this examination you will be required to undress down to your underwear (both males and females will be provided with a gown to wear, if requested)... Wait, I have to request a gown? Why don't they just give me one?
--Looking and feeling for any abnormalities around the abdomen and anal regions. A rectal examination is not performed. Males will have the external genitals examined for abnormalities. External genital abnormalities???
--Gynaecological examination will not be performed on females. If the Doctor deems a gynaecological examination necessary to determine your fitness you will be referred back to your own Doctor.
--Females are not required to have their breasts examined. If there is a problem identified in the medical history questionnaire, you will be referred to your own Doctor for further follow up.
Why do males need their external genitals examined for abnormalities? Are they that important to the defense of Australia? I have to conclude from this that the country of Australia expects that if you don't have a weapon and you are under attack that you will have to pull out your penis and stab the enemy...
More Research:
Warning: Nudity!
I stumbled across the following pictures on a single web site. They depict soldiers in combat displaying their penises. You may be outraged by the following pictures, but I would hope that you are more outraged by the disparity of the respect of human dignity that men receive in all healthcare, not just the military.
Perhaps you may say these are men in stressful situations attempting humor, rebellion, commentary, or a combination there of. They could be a means of lovers experiencing sex while one is deployed. It could also be a perversion of soldiers with damaged psyches from dignity abuses.
I propose it is the latter. I reason this from the pictures that I did NOT want to post. Some were XXX rated. I will not describe them, but you can use your imagination to estimate them when you see what I am willing to post.
All these pictures are of active duty soldiers from various countries. Most were taken during the recent Middle East conflicts. I am not an expert in identifying what country each belongs to (due mainly to the lack of uniforms), but I can guess. I also made sure that their identities were obscured.
I think I found the answer why all militaries are concerned with men's genitals....
Australian (red berets)
Definitely British
This was titled: "British forces support Prince Harry"
Unknown, but in the Middle East
Unknown, possible US, in the Middle East
Unknown, possible US, in the Middle East
US forces in the Middle East (tell by the tanks)
Unknown (Possible Russian, Czech, German)
German, this explains the "musterung"
Unknown (Possible Russian, Czech, German)
Chinese (the Red ArmY)
I guess when they say "any weapon,"
they mean "ANY WEAPON"
Yes this post was filled with sarcasm. This highlights the double standard applied to men everywhere. Then people wonder why men avoid healthcare?
I know that this title seems inflammatory, but this series of posts is all about AND from the view of (victim) patients. What is inflammatory are the cases of Justina Pelletier and Dr. Stanley Bo-Shui Chung. These are but two of the thousands of examples of physicians betrayal and abuse of patients.
Patients who have had their dignity victimized often describe their experiences liking them to the indignities suffered by the survivors of the concentration camps. More than once I have heard providers referred to as Dr. Mengele. One common attribute that they share is the fallout in their lives after the event, namely PTSD.
That all humans are capable of evil is the foundational truth of Christian civilisation. This insight — known as “original sin” — has been around for at least 2,000 years. It has been repeatedly underwritten by the crimes of history. Yet, mysteriously, people still find it shocking.
What is more dangerous is the denial by the healthcare system that their practitioners ARE capable of doing such things, AND that human dignity commonly ignored. There are some instances that outright abuse, torture, and assault occur. I wish that I could say these were rare occurrences, but they have become all to common.
So many people claim to go into healthcare for altruistic reasons but come out seemingly lacking any compassion or empathy. Patients are objectified, an entitlement to the patients' bodies permeates, and dignity and self-determination is sacrificed for efficiency, paternalism, and arrogance. Some providers are even worse.....
This has prompted me to look closer look at Nazi doctors in the concentration camps. If these physicians could abandon all ethics. Perhaps this can shed some insight to providers today.
Perhaps the most large-scale, infamous misappropriation and misapplication of medical personnel and practices and widespread perversion of medical research occurred in the Holocaust. As Lifton [Lifton RJ: The Nazi Doctors: Medical KillIng and the Psychology of Genocide.] recounts in his monumental study, The Nazi Doctors, the Nazi ‘biomedical vision’ seized on the metaphor of healing the racially diseased body of the German nation.
In this context, killing those who constituted the disease was a therapeutic venture, much as the excision of a malignant growth. “The Nazis based their justification for direct medical killing on the simple concept of ‘life unworthy of life’ (lebensunwertes Leben) … Of the five identifiable steps by which the Nazis carried out the principle of ‘life unworthy of life,’ coercive sterilization was the first. There followed the killing of ‘impaired’ children in hospitals; and then the killing of ‘impaired’ adults, mostly collected from mental hospitals, in centers especially equipped with carbon monoxide gas. This project was extended (in the same killing centers) to ‘impaired’ inmates of concentration and extermination camps and finally, to mass killings, mostly of Jews, in the extermination camps.” [Lifton RJ: The Nazi Doctors: Medical KillIng and the Psychology of Genocide.]
Lifton [Lifton RJ: The Nazi Doctors: Medical KillIng and the Psychology of Genocide.] quotes Martin Borman, “The Fuhrer holds the cleansing of the medical profession far more important than, for example, that of the bureaucracy, since in his opinion the duty of the physician is or should be one of racial leadership.” In the camps, Jewish doctors among the inmates on occasion were forced into assuming various roles in the Nazis' projects.
Lifton [Lifton RJ: The Nazi Doctors: Medical KillIng and the Psychology of Genocide.] found that many of the Nazi doctors coped with the tension between their usual selves and values and the roles that they had in the camps by ‘doubling,’ i.e., by forming a self that could tolerate and adapt to the total perversion of traditional medical values. “In sum, doubling is the psychological means by which one invokes the evil potential of the self. That evil is neither inherent in the self nor foreign to it. To live out the doubling and call forth the evil is a moral choice for which one is responsible, whatever the level of consciousness involved.” [Lifton RJ: The Nazi Doctors: Medical KillIng and the Psychology of Genocide.]
Even more disturbing than the mass killings of the concentration camps was how the prisoners were routinely stripped of all human dignity. The camps and the killing was all about efficiency. Having prisoners naked added to the efficiency and made them more compliant.
Within 90 minutes of arrival at the camps, after being stripped of possessions, clothes and all human dignity, prisoners were prodded naked down what the SS laughingly called Himmelstrasse - "the road to heaven" - to the "showers."
They complied because the guards were authority figures and the purpose of undressing was for "hygiene" and "medical" reasons. The medical aspect was to choose the which prisoners were to be used for slave labor and medical experiments, the rest were sent to the gas chambers.
Medicalization of the killing process was one of the many deceptions the Nazis used. It was partly for the victims so that they can be rendered non-resisting as much as possible, and for the Nazis, so they can see themselves as some way caring out a legitimate medical procedure.
Auschwitz was not just an extermination camp, it was the clearest example of German doctors betrayal of all their ethical training. For the first time physicians could implement death into their medical research. Buchenwald was the first camp to use prisoners for medical experiments, but it was not the only one.
Doctors had been the largest professional group to join the SS. Their crimes were so great, that a separate trial took place in Germany for them. The object of their experiments was not how to rescue or cure, but to destroy and kill.
Even TodayThe United States Military, CIA Compelled Physicians to Abuse Detainees at Gitmo
Defense Department and CIA interrogation policies after 9/11 forced medical professionals to abandon their ethical obligations to "do no harm" to those in their care and some prohibited practices, including force-feeding of hunger strikers, continue today, a report issued Monday alleges.
The report,Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror, was carried out by a 19-member task force of Columbia University's Institute on Medicine as a Profession and the Open Society Foundations. The researchers spent two years examining public records of medical professionals' involvement in military and intelligence interrogations and treatment of detainees.
It accuses the counter-terrorism operations of having "improperly demanded that U.S. military and intelligence agency health professionals collaborate in intelligence gathering and security practices in a way that inflicted severe harm on detainees in U.S. custody." (Source: LA Times, November 4, 2013)
The "restraint chair" used to immobilize and force-feed detainees on hunger strike in the prison hospital at Guantanamo Bay, Cuba. A report issued Monday said doctors and other medical professionals have been forced by the Pentagon and the CIA to take part in abusive practices that violate their ethical commitments. (Joe Raedle / Getty Images)
Even more:
A piece in the medical journal Tropical Medicine and International Health is raising questions about possible medical abuse at the prison facility because of the use of a controversial anti-malaria drug connected to serious side effects, including depression, anxiety, panic attacks, nausea, vomiting, sores and suicidal thoughts and behavior. (Source: Mintpress News, August 30, 2012)
How to explain the "Mother Theresa to Mengele" Phenomenon
There are two famous experiments that can explain the transformation that takes place among medical providers as they go through their training. They are the "Stanford Prison Experiment" and the "Milgram Experiments."
The results of these experiments was so traumatic to the participants that the Stanford Prison Experiment was stopped in less than half the time it was planned. Some have deemed these experiments unethical and should never be repeated.
The Stanford Prison Experiment
Stanford University ran an experiment that was to become famous. Known as the Stanford Prison Experiment, 24 participations were arbitrarily split into two groups, with 12 role-playing prisoners and 12 role-playing guards. The experiment was to last 2 weeks and was going to investigate the mental and emotional changes that a person goes through when they are a prisoner.
The experiment is explained in great detail in the book The Lucifer Effect by Philip Zimbardo. It is a rather harrowing read; in very little time what started out as role-playing became real life. The guards took to their new positions with brutality and mental and physical abuse was rife. The prisoners became insular and it was like an accelerated course in learned helplessness. They either became robots blindly following the guard’s requests or began to rebel – trying to escape or going on a hunger strike.
The experiment was meant to last for two weeks but was stopped after six days when three prisoners had been released early due to mental breakdowns.
All participants, whether they ended up being prisoners or guards, considered themselves pacifists and non-violent types, your quintessential hippies. But the setting and the situation changed all of this in a very short space of time. The book goes on to review the situation at Abu Ghraib prison, where prisoners were tortured and photos were taken showing the depraved behaviour. It was like history repeating itself but without someone pulling the plug after six days.
During the summer of 1971, an unprecedented experiment was conducted by Stanford University psychology professor Philip Zimbardo, involving a mockup of a prison built in the basement of the university’s Psychology Department. 24 undergraduate students were paid $15 a day to participate in what was intended to be a two-week experiement. They were either assigned a role as a prison guard or as a prisoner, and the guards were told to run the ‘prison’ as they saw fit with the one condition that they were not to use violence.
The students who were assigned roles as prisoners were ‘arrested’ by Palo Alto police officers who escorted them to the prison, fingerprinted them, after which the prisoners were given ill-fitting smocks and rubber sandals with their given ‘numbers’ sewn.Some prisoners were forced to be naked as a method of degradation.
The whole thing went out of hand relatively quickly, despite the fact that both the guards and the prisoners knew that they were participating in an experiment. A riot ensued on the second day; the prison quickly became filthy and unsanitary. Prisoners began to show severe acute emotional disturbances even within the first few days, forcing the prison ’superintendent’, Zibargo himself, to intervene on behalf of two prisoners who were eventually ‘released’ from the experiment. The guards also became progressively more sadistic, denying food to unruly prisoners, forcing them to spend time in isolation, and even making them clean the bathrooms with their bare hands. The experiment ended after six days, when it became clear that the situation was spiralling out of control in its eerie realism.
"The Stanford prison was a very benign prison situation and it still caused guards to become sadistic, prisoners to become hysterical… it promoted everything a normal prison promotes … sadism, confusion and shame. "
The following is a 29-minute long BBC documentary on the experiment:
It’s disturbing to note how people, irrelevant of personality or character, are able to impose authority, or on the other hand submit meekly without questioning, and furthermore to assume roles that are entirely made up. One must realize that an experiment of its kind, for its unethical nature, will probably never be reproduced again.
Yet, this is repeated thousands upon thousands of times each day in the U.S. healthcare system where dignity is trampled upon, building trust is not done, and authoritarianism is used in the name of entitlement (to patient's bodies), efficiency, and paternalism.
The Milgram Experiments
In the post Holocaust era, the question of how normal people could commit such horrid acts to one another haunted the American psyche. Stanley Milgram decided to investigate this occurrence, in what turned out to be one of the most famous modern psychology experiments in history.
Milgram wanted to see if normal people would comply if authority figures told them to do inhuman acts. To do this, he set up a scenario where his subjects would think that they were giving escalating shocks to a person to the point where it could be lethal. The only prodding these subjects would receive to continue giving higher voltage shocks was from an authority figure in a white lab coat telling them that they must continue with the experiment.
The results of his experiment (which are summarized here:) were disturbing, because the majority of subjects did continue to “shock” someone until the lethal levels when prodded by the authority figure.
Two slips of paper marked "teacher" were handed to the subject and to the co-subject. The co-subject was actually an actor who, in posing as a subject to the experiment, subsequently claimed that his slip said "learner" such that the unknowing subject was inevitably led to believe that his role as "teacher" had been chosen randomly.
Both learner and teacher were then given a sample 45-volt electric shock from an apparatus attached to a chair into which the "actor-learner" was to be strapped. The fictitious story given to the "teachers" was that the experiment was intended to explore the effects of punishment for incorrect responses on learning behavior.
A succession of unknowing subjects in their roles as teacher were given simple memory tasks in the form of reading lists of two word pairs and asking the "learner" to read them back and were instructed to administer a shock by pressing a button each time the learner made a mistake. It was understood that the electric shocks were to be of increased by 15 volts in intensity for each mistake the "learner" made during the experiment.
The shock generator that the "teacher" was told to operate had 30 switches in 15 volt increments, each switch was labeled with a voltage ranging from 15 up to 450 volts. Each switch also had a rating, ranging from "slight shock" to "danger: severe shock". The final two switches being labelled "XXX".
The experiment was conducted in a scenario where the "learner" was in another room but the "teacher" was made aware of the "actor-learner's" discomfort by poundings on the wall.
No further shocks were actually delivered - the "teacher" was not aware that the "learner" in the study was actually an actor who was intended, by the requirements of the experiment, to use his talents to indicate increasing levels of discomfort as the "teacher" administered increasingly severe electric shocks in response to the mistakes made by the "learner".
The experimenter was present in the same room as the "teacher" and whenever "teachers" asked whether increased shocks should be given he or she was verbally encouraged by the experimenter to continue.
These encouragements were, in fact, pre-scripted by the research team and followed this pattern:-
Prod 1: Please continue or Please go on.
Prod 2: The experiment requires that you continue.
Prod 3: It is absolutely essential that you continue.
Prod 4: You have no other choice, you must go on.
These Prods were to be deployed successively by the researchers - a higher number Prod could only be used if a lower number one had proved unsuccessful.
Each experimental session was terminated whenever Prod 4 failed to induce the "teacher" to continue administering electric shocks. In this scenario 65% of the "teachers" obeyed orders to punish the learner to the very end of the 450-volt scale! No subject stopped before reaching 300 volts!
At times, the worried "teachers" questioned the experimenter, asking who was responsible for any harmful effects resulting from shocking the learner at such a high level. Upon receiving the answer that the experimenter assumed full responsibility, teachers seemed to accept the response and continue shocking, even though some were obviously extremely uncomfortable in doing so.
How does this Happen to Physicians?
The process of becoming a doctor is so extremely challenging to most physicians cannot help but feel their survival is threatened from time to time. So behaviors/attitudes get driven into their mental programming as a Survival Mechanism. Physicians learn them at a deep subconscious level and can’t turn them off.
So what are these learned behaviors? Here are some. Some of the following learned behaviors desexualize the human body but also lead to abuses of human dignity:
being a workaholic
looking professional
hide emotions/feelings
being a "loner"
use scientific, technical language
focus on getting the task done
using a chaperone
objectifying the patient
using power to control and/or intimidate patients to do what they’re told
No instructors, professors or attendings has ever tried to "brainwash" physicians consciously and on purpose. The expectations and attitudes that create this subconscious programming are built into nearly every facet of their medical education as NORMAL and "the way things have always been done around here". [Have we heard that before?]
To most physicians in private practice the programming is invisible and unrecognized and the automatic behaviors it produces are dysfunctional and baffling. This “brainwashing” virtually guarantees physician burnout in their 40’s and 50’s AND for abuses of patient dignity to occur.
How deeply are physicians brainwashed?
Basic training in the military is 8 weeks. In that time they can condition an 18 year old to take a bullet on command. Medical education is a minimum of 7 years, for some physicians it could be 12 years. I believe there is no more thorough conditioning program on the planet than becoming a doctor.
Conclusions:
Is there a Mr. Hyde hiding in the good Dr. Jekyll?
What is the good of saving a life if the quality of that life is not worth living (PTSD)? Just because "that was the way you were taught" OR "that is the way it is done here" does NOT mean that that is the correct and most dignified way to perform a procedure. The protocols for many procedures 25 years ago would NEVER be acceptable today.
This is how some patients feel during a procedure:
I felt a woman’s uterus without her permission. How this happened, and why I thought I had done the right thing at the time, tells us something important about medical education and shows us why doctor/patient interactions often play out like conversations between earthlings and aliens.
To understand my inappropriate actions, you need to know something about the physical exams that we physicians conduct on our patients. More specifically, about the pelvic exams we perform to assess whether a woman’s uterus or ovaries are potentially diseased...
...But we know that we must overcome our nerves and practice. I certainly knew of my need to practice when I walked into the operating room that day, in 1987, gowned and gloved and prepared to assist the surgeon in any way possible...
“Student, come over here right now,” the surgeon said. “We need to start the operation, but you need to examine the patient first.”
“Come over and feel her uterus,” she told me. “She has a large uterine mass. You need to know how to recognize this kind of mass on a pelvic exam.”
“Don’t worry,” the surgeon continued. “She’s anesthetized and won’t feel a thing. Plus, her muscles are totally relaxed from the anesthetics, so you will have a much easier time feeling the anatomy.”
I inserted two fingers from my right hand into her vagina, pressed gently on her abdomen with my left, her uterus now squeezed between my two hands. Yep. Definite mass. My physical examination skills were now inching towards expertise. My surgical supervisor had helped me develop as a physician.
But of course, she’d also shaped my moral development. I had examined the woman, after all, without her permission. How could the surgeon and I have thought that it was acceptable to do this? I could only speak for myself. To begin with, I was frantically obsessed with learning my new trade. In addition, I wanted to impress the surgeon and get a good grade on the rotation. So when I stood there in the O.R. that day, presumably facing a moral dilemma, I barely gave the situation a second thought.
The result of that was that I began thinking that this kind of action was ok. The surgeon, after all, was a wonderful person, committed to medical education and patient care. And I knew that I had nothing but good intentions in examining this patient. There was nothing prurient in my behavior. I simply wanted to become a better clinician.
But I’m sure if we had woken up that woman and told her what happened, she would have been horrified. The women I have surveyed on this topic say that, while they’d be willing to give permission for medical students to practice pelvic examinations on them, they would feel violated if such practice occurred without their permission.
Moral attitudes are often a function more of our experience than of our training. When some colleagues and I surveyed medical students and asked them how important it was to ask permission before conducting a pelvic exam on an anesthetized woman, brand new medical students almost universally stated that permission was vital but by the time the students finished their OB/GYN rotations three years later, they didn’t see permission as being important anymore (see paper here).
Despite the lectures they’d received about “informed consent” during the first two years of medical school, six weeks of an OB/GYN rotation was enough to change their moral attitudes.
I have recently been reading a book titled "Medical Rape," by Lars G Petersson. You can download it as a FREE ebook here:
Warning: If you suffer PTSD, specific phobias, anxiety disorders, panic attacks, etc., this book has "triggers." I had to put this book down a couple times and then return.
MEDICAL RAPE presents a shocking story that might look like fictitious sadomasochistic porno. However, it isn’t: it is a true account of state-authorised sexual abuse. Therefore, in the name of millions of defenceless young victims, the author calls for an unconditional apology for what they were exposed to by their own country. He also demands an immediate stop to further ill-treatment.
Lars G Petersson (b. 1951) is a Swedish-born Londoner and activist with special interest in peace, mental health, environment, social justice and animal/human rights. He is the author of a large number of articles and seven books (three titles in three languages): FANEFLUGT (Danish Resistance Museum Publishing (2004), DESERTERS (2005), ABUSE UK (Chipmunkapublishing, 2010), MUSTERUNG (2010), MEDICAL RAPE (2010), HITLERS FAHNENFLÜCHTIGE (2012) and HITLER’ DESERTERS When Law Merged with Terror (Fonthill Media), 2013.
Trained as a nurse – specialising in mental health, social issues and addiction – Lars G Petersson has persistently used his insider knowledge to disclose matters otherwise hidden from public scrutiny. In a number of cases this has led to serious public debate and major improvements for vulnerable people. In one case criticism of serious maltreatment of (non criminal) Iran/Iraq war deserters in a Copenhagen prison (Amnesty International Report 1991) led to significant improvements in the treatment of refugees in Denmark. In another, Petersson’s disclosures from a psychiatric unit under the Danish Ministry of Defence led to major reforms in military ‘training methods’ of recruits.
For a number of years Lars G Petersson was coordinator for the Danish section of Amnesty International’s work against the death penalty. He is now secretary in a local London branch of the Palestine Solidarity Campaign.
An insider’s understanding of the military he achieved as a conscripted soldier (trained as a lowest possible grade fighter plane mechanic) in the Swedish air forces at the time of the cold war. Finally, he has gathered extensive knowledge of German politics and society ever since the early seventies when he worked as a massage therapist in the state of Hesse.
Lars is married to Irish Josephine, his staunchest ally, friend and collaborator and together they have two most beloved dogs, Boo and Bentley.
Lars will be writing a post for my blog in the future. He also has worked with Amnesty International, a group I greatly admire.
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.
Prevalence:
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.
I look at the world very differently, I see patterns and connections that others don't see. Think Sherlock Holmes or House M.D. (Here is a little known fact: David Shore, the creator of House, based the character of House M.D. on Sherlock Holmes.)
As i read this article, I saw the proof of the theory (sexism is alive in medicine) presented supporting the opposite conclusion. What put me over the edge was Dr. Horn admonishing someone who was acting in a very respectful manner, in dealing with a confusing situation that healthcare created and refuses to address: the position of a person wearing scrubs.
I commented on how her story did not support the title and how she disrespected patients and their families. My comment was deleted. That pissed me off. So now I am going to hit back harder.
Here is my original comment that was deleted on Kevin MD:
There is a glaringly simple answer to the problem that you present and it is not sexism. (I hope you don't diagnose patients like you diagnose social issues).
First I will address the "marry a plastic surgeon" thing. Plastic surgery is MOSTLY elective. They are usually not covered by insurances so they don't have to jump through hoops to get paid. They are happier with their profession, patients, etc.
I don't know what your speciality is (you conveniently left that out) , but unless you are going into something where the pay scale is comparable with that of a plastic surgeon, then that person spoke the truth. I will acknowledge that it may have been inappropriate, but still the truth.
Just as a physician says "we are professional and have seen it all" when a patient expresses apprehension about exposure of their body, thus making it about the physician's feelings and totally ignoring the patient's feelings: you are doing the same with this issue. Perhaps the real issue is how you present yourself:
"A natural blonde... my diminutive frame...my blonde mane...rather than a skirt suit... heels to a respectable 1.5” or less. I avoid using the word “like” too often...become disproportionately focused on the thoughts and opinions of male physicians and residents... Not that I mind a youthful complexion...a young, reasonably attractive blonde doctor... trust-fund boyfriend I had... the tortoise shell glasses, changed into my skinny jeans, a favorite sweater, suede heeled boots, put down my hair and applied a little mascara and blush." (Your words.)
LIKE, oh my God, it's Elle-izabeth Woods of "Medically Blonde."
Don't take not being called "doctor personally." In the 1970's you saw 3 people in hospitals: doctors, nurses, and orderlies. Each wore a specific uniform and were easily identifiable.
As you stated, today there are "physician... ...nurse, physical or occupational therapist, student or housekeeper" and everybody wears scrubs. Let's not forget visiting surgical company reps (demonstrating equipment in the OR), janitors (sometimes), phlebotomists, lab techs, quality control specialists, EMT, and a host of others subject to the facility's infection control plan.
Is it NOT just as disrespectful to you for someone to call a CNA doctor????
Calling you "miss" was sign of respect, respect that you are obviously LACKING for the person who called you that! Obviously they did not know your title, and used a respectful address for any unknown woman.
Obviously with that paternalistic, arrogant, everything-about-you attitude, you are fitting quite well in the medical profession quite well.
While my comment may have been slightly inflammatory, the way she disrespected patients and their families was more inflammatory. Everybody wears scrubs, there is no color coding to tell what position a person holds. People have been complaining of this for years. Calling her "miss" was polite and respectful!
Here is how she describes herself:
A natural blonde... my diminutive frame...my blonde mane...rather than a skirt suit... heels to a respectable 1.5” or less. I avoid using the word “like” too often...become disproportionately focused on the thoughts and opinions of male physicians and residents... Not that I mind a youthful complexion...a young, reasonably attractive blonde doctor... trust-fund boyfriend I had... the tortoise shell glasses, changed into my skinny jeans, a favorite sweater, suede heeled boots, put down my hair and applied a little mascara and blush.
If she is using sarcasm here, then I apologize for not catching that. I don't think that is the case though. I think that she presents herself (perhaps unconsciously) in such a manner then call it sexist when people don't take her seriously. I am not saying that this is right, and there may be some sexism involved.
There is nothing here about paying for college and med school, the burden of student loans, the years at a resident's salary trying to survive. If indeed she did have a trust-fund boyfriendthen the only way you meet someone like that is if you are in those circles. Mentioning "residency at an ivy-league institution" is another giveaway, usually implying influence of the family she comes from. I suspect that she comes from a very wealthy family.
LIKE, OMG, it's Elle-izabeth Woods of "Medically Blonde."
The frightening thing is how she deals with this issue and (more importantly) it would affect her interactions with patients and their families:
I have learned to speak up, to maintain eye contact and to assert myself if needed when rounds become disproportionately focused on the thoughts and opinions of male physicians and residents.
This is PATERNALISM! What if a patient doesn't agree with her decision of treatment?
It is troubling issue is that she aims this at ALL men. Has no man ever taken her seriously? This is stereotyping and REVERSE SEXISM. Then she makes the following comment where the man that she chose to marry is the only "good man" in the whole post, And the gender of the "trusted adviser" is conveniently undisclosed due to lack of pronouns:
During my internship, I went on a date with a good man and a couple of years later, he proposed. As I made plans for my career after residency, I met with a trusted adviser who after discussion of the several options I was considering, fellowship, research, physician positions, assured me not to worry too much. I was, after all, marrying a plastic surgeon.
I also comment on lack of disclosure of what her choice of speciality will be. All physicians are hurting financially, but general practitioners are hurting the most. The physicians that are thriving are the ones free of the bonds of medicare, medicaid, and insurance. Concierge physicians and plastic surgeons are two of these, and they are prospering. Dr. Horn fails mentioning her choice of speciality.
On July 28, 2014 KevinMD titled "Doctors today: Young, broke and human" by Aunna Pourang M.D. Indeed financial security is a major concern, even when both spouses are physicians. One being a plastic surgeon, alleviates much of the financial burden of that household.
Either I am missing sarcasm in this article, it is poorly written, or she is learning to be paternalistic. Looking at how the healthcare system operates, I go with the latter.
As a man I am offended by this post. As a patient, this post invokes fear in me of how Dr. Horn as a physician would respect my choices and my dignity.
I welcome a response from Dr. Elizabeth Horn or KevinMD.
