Preventing "sexual misconduct": The difference between medical examination and sexual abuse

Thankfully, I do not have any personal experience with sexual abuse of patients by physicians—but I am very aware that this occurs.

Therefore, I want to highlight the story of Larry Nassar to bring awareness to this issue. Nassar was the team doctor of the US women's national gymnastics team for 18 years. He used his position to exploit, deceive, and sexually assault hundreds of children and young women.

In an article published by TIME, gymnast Sara Teristi recounted the abuse she suffered by Nassar starting at age 14.^[]

The article described how Nassar—referred to by the author as “the most prolific known sex criminal in American sports history”—would massage Teristi’s chest with ice, eventually undressing her in front of another coach and commenting on her body. She recalled Nassar penetrating her anally as she lay face down on a table in later years.

Defining the abuse

Unfortunately, the term “sexual abuse” does not exist in US state regulations for physicians.

Instead, the Federation of State Medical Boards (FSMB) uses the term “sexual misconduct” to characterize this unethical behavior by doctors, according to an article published by Journal of General Internal Medicine.^[] This term refers to sexual contact between a physician and a patient, or any behavior or remarks of a sexual nature by physicians toward patients.

Is this common?

The best available statistics on this form of abuse are from imperfect sources that include self-reports or cases reported by authorities that are believed to represent fewer than 10% of all cases, according to a study analysis published by Sex Abuse.^[]

“The percentage of physicians self-reporting sexual contact with patients ranges from 3% to 12% of male physicians and 1% to 4% of female physicians,” the authors wrote. “Approximately 7.1% of all sanctions issued from 1994 to 2002 by the FSMB were for sexual misconduct.”

The Sex Abuse analysis of 101 cases found that the most common forms of patient sexual abuse by physicians included inappropriate touching (33%), sodomy (31%), rape (16%), child molestation (14%), and consensual sex (7%).

Common traits of the physicians in the incidents studied included: male gender (100%), being over 39 years of age (92%), and regularly examining patients alone in clinical settings (85%).

The study authors concluded that “there were no necessary conditions for cases to occur except for the sexual urges of the physicians.”

Why do cases go unreported?

The Sex Abuse authors cited a study that estimated that fewer than 5% of patients report this abuse by physicians, comparable to 36% of total cases reported to police by female victims in the US, according to the US Department of Justice.

Most of these cases go unreported due to fear of not being believed, shame, lack of awareness of the incident (which could occur if a patient is sedated), confusion as to if the event was abusive (for example, not being aware that an ungloved genital examination was unnecessary), or unwillingness to publicly disclose the incident, according to the Sex Abuse article.

In addition, a research article published by the Journal of the American Academy of Psychiatry and the Law found that only five states in the US have laws mandating clinicians to report on “sexually exploitive physicians”—even if they hear about it from patients during treatment sessions.^[]

The medical community must take action

I believe that physicians must be made aware early in their careers about how widespread—and unethical—sexual abuse of patients is. They must be educated at every stage of their careers on how to avoid sexual misconduct and seek help if they are struggling with urges that could violate patient boundaries.

I feel state medical boards and healthcare institutions should educate the general public on how to prevent, recognize, and report incidents of physician sexual abuse. An example of prevention: Always wear examination gloves and have a chaperone in the room when performing a genital exam.

It may be wise to record procedures when a patient is under anesthesia as a standard practice. The public should be made aware of such processes so that patients can feel more comfortable discussing allegations with patient-advocate professionals.

The medical community must mandate reporting these cases whenever such misconduct is witnessed or suspected by another healthcare professional. There should be a way to report this anonymously, and the institute should initiate any necessary measures to prevent retaliation against the reporting individual. Penalties for failing to report instances of this kind of patient abuse should be set and enforced, in my opinion.