Maintaining Proper Boundaries The Center for Professional Health www. mc. vanderbilt. edu/cph
Two Levels of Sexual Misconduct Sexual impropriety Sexual violation Federation of State Medical Boards April 1996
Sexual Impropriety n Disrobing or draping practices that reflect a lack of respect for the patient’s privacy n Examination or touching the genitals without the use of gloves n Using the physician-patient relationship to solicit a date n Initiation of a conversation regarding sexual problems, preferences or fantasies of the physician
Sexual Violation n Sexual intercourse n Kissing in a romantic or sexual manner n Touching breasts, genitals or any sexualized body part for any purpose other than the appropriate examination n Offering to provide practice-related services, such as drugs, in exchange for sexual favors
Prevalence 3% 10% 884, 974 physicians currently in practice Swiggart, W. , K. Starr, et al. (2002). Sexual boundaries and physicians: overview and educational approach to the problem. Sexual Addiction & Compulsivity 9: 139 -148.
Physician Demographics n Total Participants – 381 n Age Range - 31 to 77 (Average - 49) n Sex - Male 97%, Female 3% n States – 40 and Canada
Specialty n Family / Internal Medicine – 39% n Psychiatry – 10% n Surgery – 10% n OB / GY – 7% n Cardiology – 4% n Others – 30% Feb. 2000 – Nov. 2006 N = 365
REASONS FOR REFERRAL n Complaints from patients, family members, nurses n Affair with patient, office nurse/staff n Flirting n Cybersex
Lessons Learned How to get into Trouble
Step 1 n Date someone you supervise such as office staff, i. e. , nurse, secretary, a resident or intern
Step 2 n If someone objects to your sexual jokes or flirting assume it is their problem. You can say anything you want to.
Step 3 n Prescribe scheduled drugs or operate on someone with whom you are sexually involved.
Step 4 n Use the hospital or office computer to view or download pornography.
Step 5 n Avoid even the appearance of professional boundaries in regards to dress, language and behavior in the office.
Step 6 n Make comments about your patients underclothing, e. g. how pretty or where did you buy that?
Step 7 n Tell stories about your own sexual life. This will certainly impress your patients and make them feel more at ease during the breast exam.
Step 8 n Be present when your patient is disrobing and offer to help with those hard to reach items. Don’t use a chaperone in your office. They only make the patient uncomfortable.
Step 9 n Accept offers to meet after-hours from your patients even if it is just for coffee or a meal.
Step 10 n Flood your life with work, long hours, and ignore your personal needs. A lack of balance between professional and personal life are set-ups for problems.
Step 11 n Ignore state, federal and professional guidelines regarding sexual harassment, sexual impropriety and sexual misconduct.
Slippery Slope Late appointments with no chaperone Personal gifts Special favors Flirting, jokes etc. Grooming behavior Casual workplace
Sexual Harassment “Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when: n n n Submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment Submission to or rejection of such conduct by an individual is used as a basis for employment decisions affecting such individual Such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or offensive working environment. ”
Key Concepts n The physician holds the balance of power over patients, staff and students. n Mutual consent is not recognized as a defense for the physician. n Patient and physician emotional vulnerabilities are at the core of boundary violations. n Self care by the physician is critical to prevent hazardous romantic relationships.
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