When is Sex with a Patient OK?
Results from the DCMS committee on sexual misconduct

Doctors are sexually abusing patients and the State Board won’t take away their licenses” read the newspaper headlines when I started my year as DCMS president. I queried my colleagues as to the nature and scope of this problem, but I found no quick answers. With the Board of Directors’ approval, I appointed an ad hoc committee to help me look into the issue.

A talented and experienced group of men and women generously devoted their time to examine this issue—psychiatrists and other specialists, a lawyer, ethicists, members with extensive experience at the TMA and AMA levels, and a representative from our Physicians’ Recovery Committee. At our initial meeting, we were reminded that we all had agreed to abide by the AMA Code of Ethics when we joined DCMS and TMA. The AMA has an explicit policy prohibiting sexual contact within the physician-patient relationship.

Next, we examined enforcement of the policy. Disciplining physicians who sexually abuse patients usually falls to the Texas State Board of Medical Examiners, which traditionally has been overworked and underfunded. Therefore, we voted to support a resolution in the TMA House of Delegates asking the Legislature for better funding for the State Board. That resolution easily passed the House of Delegates and will be part of the TMA agenda for the next legislative session.

Next, we examined the treatment of sexual addiction. My research suggested a general lack of awareness among the medical community of treatment programs for sexual misconduct. The TMA Physicians’ Health & Rehabilitation Committee provided a list of treatment centers, so our DCMS Physicians’ Recovery Committee now is armed with resources for physicians who present with these problems. And the DCMS Board of Directors has adopted policy and procedures to deal with this issue.

The final charge for our committee is to educate our colleagues. My conclusions from this investigation are as follows: Sexual abuse of patients by physicians does occur. The number of cases is unclear, although I believe the percentage of physicians with this problem is quite low. Physicians share all the human weaknesses and frailties of society, so one would expect that some small percentage of doctors (as with priests, ministers, teachers, and coaches) will have a problem with sexual abuse of those under their care.

The nature of sexual abuse appears to fall into two patterns. There appears to be a handful of “sexual predators” that has sexual encounters with multiple patients; however, the majority of incidents appear to be single transgressions. Typically, these are male physicians in their 50s having an affair with a female patient in her 30s. These represent “boundary issues.” Boundary violations are equally wrong and unethical, but they do not represent the same degree of danger to society that sexual predation does. Physicians with boundary violation problems appear to be prime candidates for rehabilitation, without representing an ongoing risk to their future patients.

Whether sexual predators can be rehabilitated is unclear. There are claims that up to 50 percent of physician sexual predators might be able to return to practice after treatment. However, it seems that returning a sexual predator to a patient care setting would be conceivable only under the most stringent restrictions and monitoring, such as never being allowed alone with female patients.

It is worth noting that a psychiatrist told me of cases of female patients entrapping male physicians in order to sue for sexual misconduct. Regardless, it is wrong to have sexual contact with a patient, even if she initiates it. It is our responsibility as physicians to prevent that!

Male physicians tend to view an “affair” with a female patient the same way men used to view sexual harassment. Twenty years ago, most men did not take the issue of sexual harassment seriously. As more men have seen the problem through the eyes of their wives, sisters, and daughters, we have come to realize that it really is a problem. Sexual abuse of patients by physicians cannot be “swept under the rug” the same way sexual harassment was in the past.

It appears that we have the same level of understanding and treatment for sexual misconduct that we had of alcoholism before the AMA accepted it as a “disease” 30 years ago. Perhaps in the future, physicians will be able to claim the same 80 percent rehabilitation rate for sexual misconduct that we have experienced with treatment for drug and alcohol abuse.

We have an obligation to each of our patients individually, and to the public collectively, to protect them from harm in the physician-patient relationship. It doesn’t matter how rare cases of sexual abuse are in the profession because even one case gives us all a black eye.

So, when is sex with a patient OK? Never!

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