When Patients Behave Badly

By Patricia Campbell, DC

The doctor-patient relationship is the unique relationship that forms the cornerstone of our practice. What happens when it is compromised? Fear, uncertainty and an opportunity for abuse develop. There are many documented cases in which the doctor has been at fault.1 However, at times, it is not the fault of the doctor; a patient may make an inappropriate comment or action and compromise the relationship. A 1993 study by Queen's University researcher Dr. Susan Phillips showed 77 percent of female physicians surveyed had experienced sexual harassment by a male patient.2 Based on my own interviews with female doctors, this is an accurate, and perhaps even underestimated, number. With changing social norms, more readily available information and a better-educated population, the general opinion of doctors is decreasing - we are considered a source of information and opinion.

Sexual harassment of female practitioners is like steroid use among professional athletes. Everyone knows it happens but denies it is a problem. As more and more women enter the profession, this situation needs to be further identified and investigated. Steps need to be taken to lend support to these doctors. To date, there is no study showing the rate of harassment toward male physicians. It is felt to be lower since most male doctors are viewed first as doctors, while female doctors often are viewed first as women. In the Ontario survey, 19 percent of the doctors told no one, 53 percent told a colleague and 61 percent reported feeling angry or fearful. Sixty-five percent continued to provide care to the harasser, believing the physician could not refuse care without raising questions of family members - especially the wives. No data were available to see if the harassment continued or escalated. Most studies show the harassment will continue if ignored.3

This study shows sexual harassment of female physicians is widespread and troublesome.2 The standard action step in cases of harassment is to stop seeing the patient.1 However, many offices are family practices. Once the patient is confronted, a very awkward situation ensues, as it is typical for the patient to lie in order to save face. This also causes a financial hardship for the doctor and could be far-reaching if the patient decides to badmouth the doctor.4

Doctors of chiropractic may be at greater risk for sexual harassment due to the hands-on touch and contact of our treatments, the sharing of personal details in the history and the ongoing long-term relationships established with patients. Typically, we deal with healthy patients seeking to maintain and promote their health (not the seriously or terminally ill), so the patient feels in control of their choices. As touch and contact are not commonplace in our society, the nature of our treatments crosses many social and psychological barriers. Many patients craving contact may distort and contort the intent of the doctor's touch. The less formal, more coaching style of the practitioner, along with the perception that women doctors are more caring/compassionate, can be misinterpreted by the patient at no fault of the female practitioner. The solo clinic setup and the availability of after-hours care make instituting safeguards difficult. Most abusers are known to their victims5 and it is only opportunity that they need.

As the profession grows and develops, so too must its regulations, education and disciplinary processes. Education for patients and doctors about harassment and what it involves needs to be introduced. Not everyone has the same opinion of doctors, women in general and female doctors.

A neutral committee needs to be established for reporting harassment. If harassment continues, a letter needs to be sent to the patient on behalf of the doctor. A solid support network will discourage the abuser and encourage action by the doctor. Addressing sexual harassment and violence against women has become an issue of social conscience, and it is unacceptable behavior. It is also removing stigma and shame from the victim and placing responsibility onto the abuser. Let's make some positive changes to ensure safe offices for our doctors and protect the value of the doctor-patient relationship.

To share your experiences please e-mail . All mail will be held in the strictest confidence.

References

  1. Mechanic D. Physician discontent. JAMA, 2003;290:941-6.
  2. Phillips S, Schneider M. Sexual harassment of female doctors by patients. N Engl J Med, Dec. 23, 1993;329(26):1936-9.
  3. Ontario Human Rights Commission. "When Is It Harassment?" Available at: www.orhc.on.ca.
  4. Velasquez M. A New Era in Sexual Harassment. Sexual Harassment Prevention Center - A Diversity Training Group Affiliate. Available here.
  5. Sexual Harassment in the Workplace. Ontario Women's Justice Network. Available here.

Other Resources

  • Armstrong J. "Jury Finds Department of Veterans Affairs Liable for Sex Abuse by Resident in Home." Los Angeles Daily Journal, Oct. 11, 2001;117(119). Available here.
  • Dobson R. Women doctors believe medicine is male dominated. BMJ, July 12, 1997;315:75-80. Available here.
  • Manca D. Woman physician stalked. Can Fam Physician, 2005;51:1640-5.
  • Ontario Chiropractic Association.
  • Regulated Health Practitioner Act, College of Chiropractors of Ontario. www.cco.on.ca.
  • Yetman L. Sexual harassment: creating a chilly climate for many med students/residents. Postgraduate Medical Education, 2004.

Dr. Patricia Campbell is an instructor in biology and chemistry at Georgian College, Owen Sound Campus in Ontario, Canada.



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