Table 1. Prevalence of Sexual Boundary Violations by U.S. Physicians (adapted from Sansone and Sansone) 1
Study Authors
Characteristics
Prevalence
Number
%
% Male
From Disciplinary Actions Post 2
New York State
68/40,000
0.20% 1.60% 0.02%
--
Enbom and Thomas 3 Dehlendorf and Wolf 4
Oregon State Medical Board
77/4931
97.4
Federal agencies/state medical boards
761/?*
--
Morrison and Wickersham 5
Medical Board of California
37/104,000
0.04%
97.3
From Anonymous Self-Report Surveys Kardener et al 6
California medical society (males only)
33/460
7.20% 9.30% 3.30%
100.00
Gartrell et al 7 Bayer et al 8
AMA Members AMA Members
176/1891
93.2 96.3
26/787
AMA=American Medical Association *Total number not reported 1. Sansone RA, Sansone LA. Crossing the line: sexual boundary violations by physicians. Psychiatry (Edgmont (Pa : Township)). 2009;6(6):45-48. 2. Post J. Medical discipline and licensing in the State of New York: a critical review. Bull N Y Acad Med. 1991;67(1):66-98. 3. Enbom JA, Thomas CD. Evaluation of sexual misconduct complaints: the Oregon Board of Medical Examiners, 1991 to 1995. Am J Obstet Gynecol. 1997;176(6):1340- 1346; discussion 1346-1348. 4. Dehlendorf CE, Wolfe SM. Physicians disciplined for sex-related offenses. JAMA. 1998;279(23):1883-1888. 5. Morrison J, Wickersham P. Physicians disciplined by a state medical board. JAMA. 1998;279(23):1889-1893. 6. Kardener SH, Fuller M, Mensh IN. A survey of physicians’ attitudes and practices regarding erotic and nonerotic contact with patients. Am J Psychiatry. 1973;130(10):1077-1081. 7. Gartrell NK, Milliken N, Goodson WH, 3rd, Thiemann S, Lo B. Physician-patient sexual contact. Prevalence and problems. The Western journal of medicine. 1992;157(2):139-143. 8. Bayer T, Coverdale J, Chiang E. A national survey of physicians’ behaviors regarding sexual contact with patients. South Med J. 1996;89(10):977-982.
Therefore, although an estimated 5-10% of physicians have had sexual contact with patients, the true extent of violations is probably underreported. 13,14 Underreporting and Consequences of Physician Misconduct Most patients who are sexually violated by medical practitioners do not report it, estimated as 1 in 10, which is significantly lower than the overall U.S. rate of 36% of female rape or sexual assault. 6 The underreporting of sexual misconduct exist within a culture in which all types of physician misconduct toward patients often goes unreported: 18% of U.S. adults have experienced some type of unprofessional conduct from a physician, but only 33% reported the behavior or filed a complaint, according to survey results released by FSMB with data from 2,018 respondents. 15 Women were twice as likely as men to experience unprofessional conduct from physicians (24% vs 12%) but were less likely to report it (41% vs 30%). Patients do not report their experiences of sexual misconduct for a variety of reasons that include: 1,6 • Distrust in institutions (e.g., state medical boards, hospitals, other healthcare organizations) • Fear of abandonment or retaliation by the physician • Stigma, shame, embarrassment, and unwillingness to relive trauma
• Lack of knowledge in how to file complaints • Uncertainty over whether a traumatic event was truly unprofessional and unethical (e.g., not realizing that an ungloved vaginal examination was medically unnecessary) • Complicity in the violation (e.g., to obtain drugs) • Being unaware of the violation (e.g., under sedation) Patients frequently lack faith that boards and organizations charged with taking action will actually do so in cases of sexual misconduct. If they do wish to report the misconduct, they often feel intimidated or confused by the reporting process. Shame and guilt may arise as they wonder if they “did something” to invite the misconduct. The nature of an intimate examination may cause them to question their own version of events and wonder whether what happened was truly a violation. Even if they should overcome these barriers and come forward, many believe authorities ultimately would take a physician’s word over theirs. Unfortunately, these fears may not be unfounded. According to the Atlanta-Journal Constitution, physicians who behave inappropriately with patients have numerous advantages that protect them from consequences: 6,16 • Colleagues and nurses do not fulfill their duty to report offenses • Hospitals and healthcare organizations minimize accusations
• Organizations quietly discharge physician- offenders or push them to resign without reporting them to law enforcement or state agencies • State medical boards give physician-offenders second chances • Prosecutors dismiss or reduce charges with the goal of keeping physicians practicing and off sex offender registries • Communities support physician-offenders When it comes to disciplinary actions, sex- related offenses tend to be treated more stringently than non-sexual violations with 72% involving revocation, surrender, or suspension of a medical license in one study. 11 However, as of March 1997, approximately 40% of physicians disciplined for sex-related offenses between 1981 and 1994 were still licensed to practice. 11 For patients, the lasting effects of sexual trauma are devastating and can be life-altering. As with survivors of sexual violence in the general population, experiences of physician misconduct can produce depression, anger, drug and alcohol abuse, trust issues, and post-traumatic stress disorder (PTSD) symptoms. 6,17 They may also feel shame and guilt about the encounter. Any combination of these reactions can have the effect that the patient avoids gynecological exams or even the entire medical profession altogether with serious health consequences. 14 Thus, physician misconduct disrupts continuity of care, which is a patient right. 18
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