With women now making up more than 50% of entering students at US and UK medical schools for the first time in history, they will have to contend with one major drawback in the field: sexual harassment by patients. Unfortunately, medical associations in the United States only investigate acts of sexual harassment perpetrated by peers and supervisors, not patients. Furthermore, associations provide no formal guidance on how to respond and stay safe in situations involving patient-perpetrated acts of sexual harassment.
The US National Academies of Sciences, Engineering, and Medicine classifies sexual harassment into three categories: gender discrimination, unwanted sexual attention, and sexual coercion. Compared with trainees of the scientific and engineering disciplines, female medical trainees report higher rates of sexual harassment.
Sexual harassment of female physicians is not limited only to training but is widespread in clinical practice. Male physicians also complain of sexual harassment perpetrated by patients. According to a recent survey, one in four physicians reported being sexually harassed by patients, with female providers bearing the brunt. On a related note, sexual harassment by patients occurs at four times the rate of sexual harassment initiated by colleagues and administrators.
The pernicious threat of patient-perpetrated sexual harassment has been swept under the rug for some time. Physicians have been encouraged to toughen up if experiencing sexual harassment by these aggressors. But such harassment is threatening not only to the patient-physician interaction but also the physician’s future. One form of patient-perpetrated sexual harassment, for example, involves the patient making false claims about the physician.
Experts recommend that sexual harassment by patients be dealt with directly and proactively. It’s integral that clear written guidelines and policies be drawn up to address patient-initiated sexual harassment. These policies need to support the physician while establishing continuity of care for the patient by means of offering an alternative healthcare provider.
Acts of sexual harassment committed by patients may include:
- Comments regarding physical appearance
- Sending sexual texts, pictures, or emails
- Sexual innuendos
- Sexual propositions
- Unwanted physical contact (eg, touching, hugging, or groping)
- Self-fondling by patient
- Accusing the physician of making sexual advances
In an article published in The Lancet, Elizabeth M. Viglianti, MD, MPH, MSc, Department of Internal Medicine, Division of Pulmonary Critical Care, University of Michigan, Ann Arbor, MI, and co-authors detailed an algorithm they developed for physicians and medical trainees to follow when dealing with sexual harassment. Although the algorithm is intended for female guidance, its use may be extended to all physicians.
According to the algorithm, the physician must first ask the harassing patient to stop before attempting to proceed with care. If the patient doesn’t stop or the physician stills feels uncomfortable, possible steps include:
- Exiting the room and asking for help from another healthcare professional
- Filing a report to a superior or to authorities
- Transferring care to another physician with explicit warnings about the patient’s behavior
Patient-perpetrated sexual harassment needs to be reported by physicians. This harassment is usually unacknowledged or unreported by physicians—especially in cases where the patient has a mental illness. Conditions such as post-traumatic stress disorder, dementia, and traumatic brain injury can be used to explain inappropriate touching. However, even if these acts of sexual harassment are not intentional, it should not be tolerated.
It is important to take action against sexual harassment because it may affect your wellbeing as well as your career. Remember that if you ignore sexual harassment of any kind, you may be putting yourself and others at risk. Each physician must do their part to keep the medical community safe and effective.