Boundary Violation: Sexual Misconduct
Questions and Answers from the
Maryland Board of Physicians
What is sexual contact between the patient and the physician?
Sexual contact is not only sexual intercourse but includes any kind of inappropriate sexual touching or fondling. For a physician, sexual misconduct includes erotic behavior such as such as kissing, nudity, and sexual proposition or comment. Any erotic sexual contact between a physician and a patient constitutes sexual misconduct. Complete physical examination often includes, by necessity, touching of genitals or palpation of breasts but avoids sexual or erotic manipulation.
If I have a sexual relationship with my doctor, and I have given consent, why is this not all right?A sexual relationship between a patient and the physician is never permissible. For the patient it may mean emotional damage. For the physician it may mean the loss of objective judgment in treatment, and possibly the loss of a license to practice medicine. A healthy patient-physician relationship is essential for sound medical treatment, and most physicians understand and abide by the special trust inherent in a healthy relationship.
On television, in the movies and in many novels, patient-physician relationships are portrayed as a normal occurrence. What is the problem with this kind of relationship?
A healthy relationship between a patient and a physician is proper and should be developed by the physician for the patient's well being. This strong relationship is important to the total health care process. However, the media may send a confusing message by romanticizing and blurring the appropriate boundaries physicians are expected to maintain with their patients. The American Medical Association and the Maryland Board of Physicians, as well as most other state licensing boards, regard sexual contact between a physician and a patient as unethical conduct. It may be normal for a patient to feel attracted to a physician who is attentive, kind, and caring, but doctors have a responsibility to provide competent care without sexual exploitation.
What damage can inappropriate sexual contact cause the patient?Often, patients who have experienced inappropriate sexual behavior can feel confused, shamed, or guilty. If you suspect that you are a victim of a physician's sexual misconduct or believe that you have been sexually exploited, you should seek help by calling Maryland Psychiatric Society at (410) 625-0232 for referrals to physicians who have experience in treating sexually exploited patients. The patient's call for help will not automatically create a complaint call or trigger a report of the physician. Patients should report sexual misconduct to the Maryland Board of Physicians.
How does the medical community view sexual exploitation?
The medical community views sexual exploitation as a doctor using a patient for sexual gratification. Sexual contact between a patient and a physician represent inappropriate behavior and as such violate standards of the medical profession. The physicians must keep sex out of the patient-physician relationship, even when the patient initiates sexual overtures.
I really like my doctor and we have a very good relationship. We joke and kid about a variety of things. Could this present a problem?
Yes it could. However, if a patient acts in a seductive manner or makes overtures to the physician, the physician must respond in a professional manner. The physician must avoid comments or behavior which could be interpreted as flirting or an invitation to a sexual relationship. Physicians should also avoid sharing personal sexual problems with patients but may inquire into a patient's private life if this information is needed for medical reasons. All examinations should be done in a way which is sensitive to the patient's modesty or that will prevent possible embarrassment. A physician should carefully explain the purpose of the examination and exactly what is about to or will happen during the examination. This may help prevent any misinterpretation of the physical examination and reduce the patient's anxiety about the necessity or appropriateness of any touching that may occur
What purpose does a chaperon serve?
Primarily, the chaperon eases the concerns of the patient during more intimate examinations, and secondarily, the chaperon protects the physician from unfounded sexual misconduct accusations.
Should I ask my doctor to provide a chaperon during more intimate examinations?
The patient may request that a nurse, friend, or family member act as a chaperon. Whenever uncomfortable with any part of an examination, the patient may ask the physician to stop. Although it is not required, the cautious physician will ask if the patient would like to have a chaperon present during more intimate examinations. Most women desire a chaperon for a pelvic examination when the physician is a male, but have no preference or may decline a chaperon if the physician were female. Male patients almost never want a third person in the room regardless of the sex of the physician. If you would be more comfortable having a chaperon in the room during your physical examination, by all means request one!
Are there any warning signs of which I should be aware?
Warning signs include making seductive overtures, discussing personal sexual life, asking to meet socially outside the office or during non-office hours, physical caressing or touching in a sexual manner, providing alcohol or drugs during treatment sessions. Warning signs almost always precede unethical behavior.
If I change physicians, is it ever possible to see a former physician socially or romantically?
At a minimum, the patient-physician relationship should be severed prior to any social or romantic relationship. For psychiatrists, a romantic relationship with a current or former patient is prohibited under the ethical standards for psychiatry and may result in disciplinary action by the Maryland Board of Physicians.
This page was posted on March 12, 2008.