Clinical Sexual Misconduct


Sexual misconduct is a term for variety different sexual acts. This is a problem that lies in clinical, legal, and ethical judgment of a person. One of the many types of misconduct occurs in professional relationships. When a physician advances sexual acts upon a client or patient this constitutes as sexual misconduct. This type of behavior is obviously wrong and unacceptable. In the case outlined in the text concerning a dentist’s inappropriate sexual contact; there was evidence that while under dental care the practitioner engaged in physical and sexual relationship with five different patients. This type of thing happens more than some may think. In this case there was an obvious wrong due to the ages of the patients. The dentist advanced to patients from age seven to fifteen (Pozgar, 269). This would not only constitute as misconduct, but also a statutory case.

Transference and counter transference is one of most important aspects of treatment between patient and practitioner. Transference is defined as the redirection of feelings and desires and especially of those unconsciously retained from childhood toward a new object (Merriam-Webster). Counter transference is when a practitioner has complex feelings toward the patient (Merriam-Webster). In a clinical setting we do not always notice these occurrences. Sigmund Freud coined the term in 1910 in "The Future Prospects of Psycho-Analytic Therapy". The term later expanded to include unconscious hostile and/or erotic feelings toward a patient that interferes with the treatment and or professional relationship. Counter transference can be the feelings that a provider shows toward his or her patient, and also includes cases where the therapist takes on the suffering and pain of his/her patient. An example of this would be a patient that was a victim of a rape. We as their provider while listening to their situation would put ourselves in their shoes and feel the pain and the torture that the patient felt.

Training, knowledge, and their education give physicians a sense of power. Patients come to their physicians fearful and vulnerable. Secrets are revealed, clothes are removed, and skin is touched. Physicians are trusted to serve their patient’s best interests. Physicians may use these events to further scar a person for nothing more than their own personal pleasure. Sexual misconduct by physicians can create a false sense of security that is ultimately detrimental to the patient. This can scar a patient from ever trusting a healthcare provider of any kind. Not to mention that this goes against any health care professionals ethics and oaths (such as the Hippocratic Oath).

In 1990 the American Medical Association (AMA) council on ethical and judicial affairs released their report "Sexual misconduct in the practice of medicine." The AMA Council decided that sexual contact or a romantic relationship conducted while in the care of a physician is unethical. A romantic relationship with a former patient may be considered unethical, but this would depend on the circumstances. Sexual misconduct is also discussed in medical training programs. Reporting these offenders is an important responsibility that should be upheld.

Most physicians agree that sexual relationships should not be part of the physician-patient relationship. However, a wider range of sexually exploitative behaviors are commonly overlooked. Examples of this may be an inappropriate joke or a comment about a woman’s tight clothing. These things seem like they are harmless, but still are considered inappropriate. If the comment has no diagnostic and therapeutic purposes, it should not be stated. Some actions that should be avoided include hugging, romantic kissing, touching any sexualized body part for any purpose other than examination or treatment. Discounting or offering medical-related services or prescriptions in exchange for sex is unacceptable.

The AMA states that a physician's ethical duties include terminating the physician-patient relationship before initiating a dating, romantic, or sexual relationship with the patient. A relationship with a former patient is unethical if it uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship. The AMA does not address the appropriate length of time between the termination of the physician-patient relationship and the initiation of a romantic or sexual relationship. Regardless of the conduct or consent of a patient, the physician is felt to be in the more powerful position in the relationship and thus responsible for even "consensual" boundary violations. A physician within the facility that I work for is the prime example of this. I will refer to this physician as Dr. Jones for confidentiality reasons.

Dr. Jones had a lucrative practice. He was one of two specialists in his area of expertise in a wide area. He was very good at his job and he was liked personally by everyone that I would speak with. Mr. Jones had a professional patient relationship with Mrs. Doe. Ms. Doe’s medical problems were under control but she did need to come back and follow up with the single physician often. There was a point when they started chatting at the visits about their personal lives. That turned in to emails and then phone conversations; then a mutual kiss. After the kiss the physician thought that it would be a good idea to refer to another physician. Over about a year and a half the relationship was consensual as they mutually conducted a sexual relationship. Mrs. Doe was married. The physician however; was a single man. There relationship went on for about six months or so and then Mr. Doe, Ms. Doe’s husband, learned of the affair and made Mrs. Doe report Dr. Jones to the State Medical Board. Most people would look at this as two consensual people entering into a relationship; there was enough emails and correspondence produced to prove that Mrs. Doe entered into this relationship willingly; so what is the problem? They are both consenting adults. She was the married party she was the one in the wrong right? Wrong! Physicians are held to a higher professional standard. As soon as he started to experience those feelings he should have referred her to another physician. Not after he had already crossed the ethical line. That is why his license is now suspended for a minimum of six months and he is required to do all types of ethics training. Just goes to show you that this type of thing happens and is taken very seriously. When in doubt refer the patient.

I hold a medical license in the State of Ohio that I worked very hard for. I can see very easily how things like this can happen. I have been on both sides of this example. As a massage therapist I take the sexual jokes of friends and my friends friends’. I will say that it is a fine line when you are working with people’s bodies. I constantly ask questions and explain my procedures very clearly before a session takes place. I have had to refer a patient to another therapist because the lines of professional and personal seemed to be a bit blurry and not even on a sexual level on a personal one. I have been in situations that a client was looking for more than a therapeutic relationship and I had to end the session. These types of things do happen but my medical license, my integrity, and name are not worth the risk.

References

Pozar, George D. (2010). Legal and Ethical Issues for Healthcare Professionals. 2nd ed. Jones and Bartlett Publishers. Sudbury.

transference. (2010). In Merriam-Webster Online Dictionary.
Retrieved February 1, 2010, from http://www.merriam-webster.com/dictionary/transference

countertransference. (2010). In Merriam-Webster Online Dictionary.
Retrieved February 1, 2010, from http://www.merriam-webster.com/dictionary/countertransference

.. Retrieved February 1, 2010, from http://classics.mit.edu/Hippocrates/hippooath.html

.. Retrieved February 1, 2010, from http://www.ama-assn.org/

.. Retrieved February 1, 2010, from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion814.shtml

.. Retrieved February 1, 2010, from http://www.med.ohio.gov/

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