When it comes to protecting your practice, we often think of office compliance, but in this case, we are talking about health care’s worst kept secret — sexual harassment. A 2018 Medscape study surveyed 6,235 healthcare providers and found that patients sexually harassed 27% of doctors. The most common behaviors described included overt sexual harassment, repeatedly asking for a date, and unwelcome touch and groping. (Kane, 2018) What is worse is that in 1993, researchers in the New England Journal of Medicine reported that up to 75% of female doctors were sexually harassed by patients but very little was done about it until the birth of the #metoo movement. (Phillips & Schneider, 1993) In addition, most CE classes required by doctors to maintain licensing in their states have only addressed sexual harassment from the perspective of the doctor as the perpetrator, providing little to no guidance for doctors and their staff on how to handle being harassed by their patients.
So why is harassment underreported in health care? In 2014, a study was published on the sexual victimization of men, finding that men were much more likely to be the victims of sexual abuse than was thought. The common one-dimensional stereotype of women as victims reinforces outdated gender stereotypes. The assumption that men are always perpetrators and never victims supports unhealthy ideas about men. These stereotypes all too often make male victims feel too embarrassed to report. (Meyer & Stemple, 2014) In another survey, 40% of doctors and staff felt that reporting it would not be impactful, while 21% felt ashamed or embarrassed. (Viguers, 2020)
The lack of reporting is perpetuating a problem that has gone on for far too long, leaving doctors and their teams ill-equipped to handle and stop such situations when they arise. The first sign of inappropriate behavior is when a patient’s actions or conversation make providers uncomfortable. Patients making inappropriate comments will first “test the waters” by making inappropriate jokes or favorable comments to gauge your response. If you dismiss the comment, the patient will likely continue with the inappropriate conversation or actions. Here are four steps to follow if a patient sexually harasses you or your staff.
Be direct. Calmly and firmly tell the patient that their behavior is inappropriate. Make it clear they need to stop immediately. One of the most common forms of harassment is persistent requests for a date. “Mr./Mrs. Smith, I am your doctor, and that is inappropriate. For me to provide you the best possible care, I insist that you keep our relationship professional.” In many cases, these establish clear boundaries, and the patient will stop the behavior immediately. One male doctor did not address this situation directly with a patient. When he failed to take his patient up on her repeated requests for a date, he found her leaning up against his car one evening when he walked out of his practice alone.
Document. While the incident is still fresh in your memory, write down what happened. Record the time the harassment occurred, where you were, who was involved, and who was nearby that may have seen or heard the incident. In a recent conversation with Dr. Daniel Cote, NBCE president and District I director, he stated that providers should document the incident in the patient’s medical record. “Mr./Mrs. Smith asked me out on a date. I stated that, as their chiropractor, our relationship was professional, and that it was inappropriate.” Keep in mind that patients can request and read what is in their medical record, and this information should be precise but worded in a way that is not offensive.
Establish a formal policy. If you do not have a sexual harassment policy for your practice, you should establish one immediately. It needs to outline all employees’ steps in these situations, including how and where to document the incident. The policy should also designate a person in the practice who should be notified immediately of every incident.
Additional options. If a patient has harassed you or a staff member, you should have additional options to help you feel safe. For example, have someone in the room with you when treating the patient.
If, after exhausting all of these procedures, your patient is still harassing you, it’s time to ask them to leave the practice. Many states have abandonment rules when it comes to asking patients to leave the practice. You should contact your state association to seek guidance on the best way to handle this situation.
Taking preventative steps now can help you and your staff avoid awkward situations with patients and help you be more prepared when faced with them. Start by educating your entire team on your harassment policy, role-play how to handle situations with patients, and go over what actions constitute sexual harassment. (PSQH, 2019) For example, manual manipulation, massage, and other treatments to the low back can elicit an involuntary response, like an erection, that is in no way sexual. However, doctors and staff need to be aware of this to handle it professionally and not embarrass the patient. One practice shared with me how this happened during a therapeutic massage; unfortunately, the massage therapist did not handle the situation because of a lack of training and understanding. As a result, the patient was embarrassed and has not returned to the clinic, and the massage therapist turned in her notice.
In June of this year, when I was asked to address sexual harassment as part of a panel discussion, I had no idea how widespread the problem was within health care, specifically the chiropractic profession. What started as an opportunity to address sexual harassment from a different angle has since turned into a mission to help chiropractors and their teams have a safe and respectful work environment.
After the first panel discussion, I was followed into a restroom where three female doctors shared their stories of sexual harassment from patients. An hour later, two male doctors followed me outside to share their stories of sexual harassment. One told me that he had not even shared his experience with his wife because he was embarrassed about the incident. They are not alone. In the months that have passed, many doctors and staff members have heard about my class and reached out by phone and email to share their stories, often for the first time, hoping that sharing it with me will help others. It’s a responsibility that I don’t take lightly.
Kristi Hudson is a certified professional compliance officer (CPCO). She serves as the Director of Business Relationships for ChiroHealthUSA where she has helped to educate DCs and CAs on establishing simple and compliant financial policies. You can contact Kristi at 888-719-9990 or [email protected], or you can visit the ChiroHealthUSA website at www.chirohealthusa.com.
References
1. Kane, L. (2018, July 11). Patients Sexually Harassing Physicians: Report 2018. Retrieved from Medscape: https://www. medscape.com slide show patients-sexually-harassing-physicians-6010036
2. Meyer, I. H., & Stemple, L. (2014, June). The Sexual Victimization of Men in America: New Data Challenge Old Assumptions. Retrieved from NCBI: https://www.ncbi.nlm.nih.gov/p... PMC4062022
3. Phillips, S. B., & Schneider, M. S. (1993, December 23). Sexual Harassment of Female Doctors by Patients. Retrievedfrom The New England Journal of Medicine: https://www.nejm.org/doi/ fidi/10.1056/NEJM199312233292607
4. PSOH. (2019, October 11). 0&A: Dealing with Sexual Harassment in Healthcare. Retrieved from PSOH: https://wwwp)sqh. com analysis qa-deaiing-with-sexuai-harassment-in-heaithcare
5. Viguers, S. (2020, October 21). Many Physicians Experience — But Do Not Report — Sexual Harassment. Retrieved from Healio: https://www. healio. com news primary-care 20201020 many-physicians-experience-but-do-not-report-sexual-harassment
