Last month, the University of Southern California (USC) reached a $ 852 million deal with more than 700 women who accused former gynecologist George Tyndall of sexually abusing them while they were his patients, and who accused the school of trying to cover it up. This case resulted in the largest sexual abuse agreement with a university and the largest personal injury agreement of any university or history in U.S. history. Tyndall denied the wrongdoing, but later lost his medical license and has been criminally charged with sexually assaulting several patients under the guise of gynecological examinations.
Another case involving multiple women was filed against a gynecologic oncologist working at the University of California, Los Angeles (UCLA). James Heaps, MD, was charged with a repeat cancer patient sexual assault for 2 years of treatment. The lawsuit adds to previous allegations of sexual assault by 22 women.
These are just two high-profile cases that broke the news. Many others may not be headlines, but they are occurring.
The Federation of State Medical Boards (FSMB) notes that in 2019, 251 disciplinary actions (out of a total of 1638) were specifically taken against doctors for infractions of “sexual misconduct”.
The actual number may be higher because boards often use a variety of terms, including unprofessional behaviors, physician-patient boundary issues, or moral inadequacy, to describe these actions, the FSMB explains.
Also, because the data is collected, there is no information on whether the case specifically involved a patient (or another person).
“This data comes directly from the state medical boards at the FSMB,” said Joe Knickrehm, vice president of communications at the FSMB. Medscape Medical News. “We cannot say definitively that all these disciplinary actions are the result of sexual misconduct on a patient. A disciplinary action that was coded as ‘sexual misconduct’ could have taken place with a patient, a colleague, a student. in training, office staff or others. “
Knickrehm noted that the FSMB is encouraging state councils to begin implementing more consistent coding practices that will make clear the underlying reasons for a complaint or disciplinary action.
The FSMB calls for stronger action on physicians’ sexual misconduct and makes new recommendations to viewpoint article published March 29 a JAMA.
“The medical profession must promote a culture in which sexual conduct is not tolerated in any way,” the FSMB states. “This behavior undermines professional achievement and, when this behavior is tolerated, openly or tacitly, reduces the likelihood of reporting and erodes professional culture in a patient-centered system.”
The FSMB report focuses primarily on sexual misconduct that may involve a patient, which is defined as behavior that sexually exploits the physician-patient relationship. This type of behavior between a doctor and a patient is never diagnostic or therapeutic, it can be verbal or physical, and it can occur in person or virtually.
“When it comes to patients, there is such a big power differential between them and doctors that if we want patients to report more, we have to make it easier,” commented Arghavan Salles, MD, doctor, surgeon, special advisor for patients. DEI programs and senior researcher at the Clayman Institute for Gender Research at Stanford University in California.
“Just as asking people if they are safe at home is now a routine part of some doctor visits, wondering if patients feel hurt in some way during the visit can become routine.” , he said.
Sometimes it’s a genuine misunderstanding, but historically the risk of falsely notifying is pretty low, Salles said. Medscape Medical News.
“That said, the way complaints are handled is critical,” Salles stressed. “It takes enormous courage to denounce and those who denounce must feel supported. Defendants, of course, should also be able to share their side of the story. Cases of misunderstanding could be resolved through this process and the most serious infringements should be addressed. “
Salles also commented on the independent issue of sexual conduct and harassment in the medical profession.
Results of Sexual Harassment of Medscape Doctors: 2018 Report show that 12% of doctors and 4% of men said they have personally experienced sexual abuse, harassment or misconduct in the last 3 years. Among doctors who reported harassment, 47% said the perpetrators were other doctors; 16% said they were harassed by nurses.
“One of the areas for improvement would be to make sure that people who harass or assault other people cannot easily move to another institution,” Salles said. “What we see, all too often, is that when men and sexual harassment almost always make them men, harass or assault other people, they usually have no consequences. If and when they face local consequences, they usually get help finding a job at a new institution “.
“This practice, which can be called‘ passing the bully ’or‘ passing the rubbish ’, has to stop,” he added.
Recently, the FSMB has conducted a review of practices related to the treatment of reports of sexual misconduct (including harassment and abuse) toward patients by physicians. Specific recommendations of this review, adopted by the FSMB Chamber of Delegates on May 2, 2020, includes the following:
The medical profession must promote a culture in which sexual misconduct is not tolerated.
Members of the medical profession must recognize their ethical “duty to report”.
State medical boards must ensure that there is sufficient public information (without violating the privacy of complaints) to justify regulatory decisions and provide sufficient grounds to support them.
State medical boards should implement clear coding processes for board actions that provide accurate descriptions of the behaviors underlying the board’s disciplinary actions and clearly link licensees ’behaviors to disciplinary actions.
State medical boards are encouraged to provide clear information, education, and guidance on how to file a complaint with the state medical board, and why complaints are needed to support effective regulation and safe patient care.
State boards must act quickly, especially when the continued practice of medicine poses a danger to the public. When this risk is perceived to be high enough, as in the case of sexual assault, actions should include the suspension or summary (immediate) revocation of a physician’s medical license and notification of law enforcement, both while the investigation is ongoing and as part of a final award.
Sexually misconduct researchers hired by state licensing boards should understand the trauma, including the history, long-term sequelae, and effects on emotions and memory.
As for the real role the FSMB plays in the discipline of physicians, Knickrehm noted that this corresponds to the authority of the state’s medical and osteopathic boards.
“However, the FSMB supports our councils with policy recommendations and guidance and serves the public by raising awareness about the work of state councils and offering a free resource called DocInfo (docinfo.org) that provides professional information and disciplinary action for each physician. authorized and medical assistant in the United States, “he said.
That said, state boards appear to be intensifying amid the increased focus on sexual harassment and misconduct. “We have heard encouraging news from various boards that have reviewed the FSMB’s policy on sexual misconduct by doctors and made changes to some of its research processes and increased public awareness campaigns about the importance of reporting inappropriate behavior. from a doctor to a state doctor, ”Knickrehm added.
Alok Patel, MD, clinical instructor in the pediatrics department at Columbia University College of Physicians and Surgeons in New York City, came up with comments to consider that sexual misconduct is widely described. Sexual misconduct also generally follows a spectrum of severity that can begin with “preparedness” behaviors and end with sexual assaults, and Patel suspects that behavioral behavior in general is also uninformed.
“When it comes to patient-private interactions, awareness needs to be there not only so that healthcare providers are not only more self-aware, but also motivated to talk to patients and others with full transparency. so that their actions are not misinterpreted. ” He said.
As an example, Patel pointed out, a doctor may say something about it: “I need to check my femoral pulse, let me tell you how to do it better.”
To change the culture, the need for explanations must be “absolutely integrated into the curricula of medical schools,” Patel said. “Not only do medical students understand how and why patients misinterpret actions / words, but medical students also understand the potential repercussions,” he noted. “Perhaps medical students could hear anecdotes from patients themselves, see examples, etc. Some medical schools have done a decent job inculcating cultural competence and anti-racism protocols in their clinical curricula, this should be spread to sexual misconduct. “
It is important to note that Patel stressed that health care providers need to understand what is really meant by sexual misconduct and understand intentions and how they can be perceived. “They must also understand that zero tolerance policies will be maintained and what exactly a Title IX informant is required to do,” he added.
Salles has not revealed any relevant financial relationship. Patel reported that he served as a director, officer, partner, employee, advisor, consultant or administrator of Medumo Inc.
JAMA. 2021; 325 (16): 1609-1610. Summary