Crossing professional boundaries in medicine: the slippery slope to patient sexual exploitation

Abstract

While some cases of sexual exploitation involve predatory doctors, many other cases represent the culmination of a series of boundary crossings (non‐exploitative departures from usual practice). The deliberate move to reduce formality in medicine has increased the likelihood of boundary crossings and violations. There are also individual doctor risk factors; boundary violations appear more likely when doctors are under stress, with insufficient emotional support. Preventive strategies include continuing education about ethics and the management of professional boundaries, along with appropriate psychological support structures for doctors. Doctors are often involved in other professional relationships as teachers, supervisors and team leaders; inappropriate sexual behaviour in these relationships is harassment. Public pressure for more punitive responses is likely if the profession is not seen to be doing all it can to deal with these issues effectively, and to be cooperating with other responsible agencies.

Dimensions and Determinants of Trust in Health Care in Resource Poor Settings – A Qualitative Exploration

“…Establishment and clear maintenance of professional boundaries is strongly emphasized. [26], [27] This can be contrasted with the research finding in this study where personal involvement with the patient was considered as favorable for trust building. Gift giving and accepting gifts from patients has been a matter of discussion in the context of professional doctor patient relationship.…”

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs

“…Structural factorslargely outside of the control of individual physiciansinclude institution-specific factors (e.g., a local culture of leniency or punishment regarding boundary violations) as well as issues in the wider medical and social world: (1) a medical culture which esteems self-reliance and minimization of personal needs [11], (2) expectation that physicians police themselves, (3) a legalistic climate [8,12], and (4) the rise of social media and related technologies [13]). Proximal, individual factors include more timelimited, remediable and situation-specific aspects (e.g., lack of information about specific laws and guidelines), as well as personality traits (e.g., decreased emotional awareness/mindfulness, impaired emotion regulation, lower empathic capacity), and states of social and professional isolation [14,15].…”

Sexual harassment allegations against doctors: Facts and fiction

“…exploiting patients' trust to serve their own sexual gratification is similar to abusing a child by its parent [1,2]. Sri Lanka Medical Council considers that a doctor entering into an emotional or sexual relationship with a patient or with a member of the patient's family which disrupts the patient's family life or otherwise damages or causes distress to the patient or his or her family is culpable of serious professional misconduct [3].…”

“…Such news items draw quick and aggressive attention of the public, doctors as well as health authorities. Irrespective of the truth of such allegations or the outcome of investigations, the alleged doctor as well as the profession as a whole faces embarrassment in society, in hospitals and even in their homes [1]. Such sexual harassments do exist and the reported cases can only be the tip of the iceberg [4].…”