Case Study 3 Instructions: Please read through the case study below and consider the questions that follow.
A woman presented to a male family medicine physician for treatment of a spinal injury suffered in the workplace. A female chaperone was invited into the room by the physician and was present throughout the examination. The physician began by assessing the patient’s pain level and history of injuries. The physician then handed the chaperone a closed laptop and asked her to record the information from the physical exam and history in the patient medical record. He then turned to the fully clothed patient and began an examination of her spine from top to bottom. He asked her to reach down and touch her toes and when she did so, he put his hand in her underwear and inserted an ungloved finger into her anus. He did not explain why this was a necessary medical procedure, nor did he obtain informed consent prior to performing this action. When she turned her head to assess the physician’s intent, she found him smiling at her with his finger still inserted. Quickly, he told her she could straighten up then turned to the sink and washed his hands, explaining that he did not believe she had a fracture in her spine. The chaperone who had had difficulty accessing the patient record was now entering information into the laptop as previously instructed. The patient objected verbally to what had just occurred. The chaperone had not observed the behavior.
1. What actions might the chaperone take?
2. What training is necessary for chaperones to perform their duties, and what is a physician’s responsibility?
Questions for case study: Discussion: The chaperone is there to act as a witness and should stand in a location where the examination can be observed. A chaperone has the right to stop a sensitive procedure or examination if they suspect the physician’s behavior is inappropriate. In this case, the chaperone did not witness the behavior directly or stop the exam. But the patient complaint of unacceptable behavior means the chaperone should immediately report this incident to the appropriate manager, who should ask the patient if she would like to file a complaint and/or criminal charges. It is a physician’s responsibility to know what constitutes appropriate training of a chaperone and to ensure that the presence of a chaperone provides protection to the patient through observation and reporting. More uniform expectations and clear education in regard to chaperones adopted throughout the medical profession can help ensure that they provide more than the illusion of safety and that harmful (or criminal) behaviors do not go unnoticed.
Considerations all physicians should weigh when online include the following: 45 • Maintain patient privacy and confidentiality, refraining from posting identifiable patient information • Follow ethics guidance regarding confidentiali- ty, privacy, and informed consent when posting for educational purposes or to exchange in- formation professionally with other physicians • Use privacy settings to safeguard personal information and content while realizing privacy settings are not absolute and content on the internet is likely permanent • Routinely monitor own internet presence to ensure that personal and professional information and (to the extent possible) content posted about oneself by others is accurate and appropriate • Maintain same appropriate boundaries of the patient-physician relationship as in any other context if interacting with patients • Consider separating personal and professional content online • Bring unprofessional content posted by any colleague to the attention of the individual; if behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, report the matter to appropriate authorities • Recognize that actions online and content posted may harm reputations, have consequences for medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession
The page contains information on underserved victims of sexual assault, including the elderly, culturally-specific communities and limited English- proficient speakers, people who are deaf or hard of hearing, American Indian and Alaskan Native women, children and youth, individuals who identify as LGBTQ, immigrant women, male survivors, and people who live in rural populations and communities of color. Other resources for physicians are shown in Table 4. 1 This is not a comprehensive list but gives some guidance on preventing sexual misconduct and maintaining professional boundaries, providing trauma-informed care, and understanding and addressing implicit bias. Resources and Education for Patients It is essential that patients know how to file complaints about their physicians to state medical boards. But roughly half of Americans do not know that medical boards are responsible for licensing and regulating physician practice in the United States. 15 Only 3 in 10 Americans say they know how to find out if their physician’s medical license has received a disciplinary action. 15 Some mistakenly believe the best resource to contact is the physician’s office or hospital, the AMA, or a lawyer. It must be reemphasized that responsibility of ensuring competent, professional care lies with physicians. 30 However, patients are empowered by information, and it is appropriate to provide them with written education (for example, ACOG’s “Your First Gynecologic Visit”). 38
Trauma-Informed Care Individual trauma results from an event, series of events, or set of circumstances experienced as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. 1,46 Trauma-informed programs, organizations, or systems: 1,46 • Realize the widespread impact of trauma • Understand potential paths for recovery • Recognize signs and symptoms of trauma in clients, families, staff, and others • Respond by fully integrating knowledge about trauma into policies, procedures, and practices • Seeks to actively resist re-traumatization Physicians should also be familiar with how trauma can affect investigations. With a patient- complainant who has experienced trauma, the emotions may not appear to match circumstances of the complaint, the report of the event may not be linear, and seemingly salient details may be unreported or unknown to the complainant. 1 The Ohio Alliance to End Sexual Violence maintains an online resource (https://oaesv.org/ what-we-do/resources-for-providers/advocates/) for providers and advocates to facilitate the survivor’s recovery process, from immediately following the crime to decades later.
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