COMMENTARY

The Physician's Role in Reporting Sexual Abuse

Arthur L. Caplan, PhD

Disclosures

March 19, 2018

Hi. I'm Art Caplan. I'm at the New York University (NYU) School of Medicine, where I head the Division of Medical Ethics.

As you probably know, Dr Larry Nassar, who was the [national team doctor] to the USA Olympic gymnastics team and many other aspiring gymnasts, is going to spend the rest of his life in prison.

Dr Nassar sexually molested hundreds of young girls, sometimes with their parents present in the examining room. He made the manipulation of their genitalia part of an exam, and he would say that it was part of appropriate medical procedure and treatment. The young women, even some of them who complained to their parents, came away thinking, well, maybe that's right.

We clearly have a problem with predators who work their way into medicine and prey upon young women, and sometimes upon older patients as well, particularly women. It's a problem that exists in medicine, it's a problem that exists in dentistry, and to a little bit of an extent, it exists in nursing as well. What ought we to take away from the Nassar case for medicine?

First, I think it's important that whenever women or children are being examined, the offer should be made to have someone in the room with them, whether it's a nurse or some other aide. I think people will feel more comfortable, post-Nassar, knowing that they could have someone in the examining room with them if that is what they want to do.

Second, everybody should receive an explanation of what a physical examination is and what medical procedures are going to be done, and why, so that they know what the limits are of what's supposed to happen in terms of an exam or any other touching of the body. They're owed that explanation, and I think we shouldn't presume that they know. People are often confused about what's appropriate and inappropriate, and it should be laid out for them.

Most important, I think we've got to be ready to blow the whistle if we hear from a young woman, any type of a patient, that she thinks she may have been molested. USA Gymnastics did not tell its coaches that they should report. There was no obligation on the part of sports physicians and other therapists to report suspicions of abuse. That's going to be changing. I think medicine has to get closer to a zero-tolerance posture as well.

We've seen these problems of sexual predation moving through areas like the priesthood. We've seen problems come up in the entertainment industry. We've seen issues come up in business. We've seen them come up in the military and academia. In medicine, to cement patient trust, we just cannot tolerate someone who abuses or takes advantage of patients, or exploits them sexually or otherwise.

If you hear about something, if someone complains, I think your duty is to report it to the medical board. Report it also, in certain instances, to child welfare and child abuse authorities. Let them take the investigation from there. You're not convicting anybody. It's just going to trigger an investigation.

It's tough, because I believe that this is not by any means a common or frequently occurring problem. It's a few predators who work their way in and exploit their rights and privileges as a medical professional. They damage the trust that the public has in all of medicine. They cost everybody a lot of money in terms of lawsuits and litigation, and they scar too many patients when they're left to do their damage unchecked.

I think that reporting suspicions, trying to ask questions if someone seems disturbed or worried about a prior visit that they had with a medical professional—that's important. It's part of the obligation that we in healthcare all ought to have.

I'm Art Caplan at the Division of Medical Ethics at the NYU School of Medicine. Thanks for watching.

Talking Points: The Physician's Role in Reporting Sexual Abuse

Issues to consider:

  • Most patient-victims do not report sexual violations.[1]

  • It is estimated that fewer than 1 in 10 patient-victims choose to report sexual assault, a rate significantly lower than the overall rate of 36% of cases of rape or sexual assault in the United States reported to police by female victims.[1]

  • Sexual violations cause significant harms to patients. Some data suggest that patients who enter into "consensual" sexual relationships with their physicians are typically not mentally healthy, and these encounters occur most often where considerable disparities in power, status, and emotional vulnerability exist between physician and patient, making consent not applicable.[1]

  • Reasons for failing to report sexual abuse may include shame, fear of not being believed, not being aware of the abuse (eg, if the patient was sedated), complicity in the violation (eg, trading sex for drugs), and being confused as to whether abuse occurred (eg, not realizing that an ungloved vaginal exam was unnecessary).[1]

  • Hospitals or physician employers sometimes ignore reports of abuse or ask for a resignation rather than reporting physicians to medical boards or law enforcement.[1]

  • In a study led by Washington University School of Medicine researchers, which examined 101 cases of sexual abuse of patients by physicians, the primary motives in most of the cases appeared indistinguishable from the acts themselves. No motive was apparent other than the performance of the sexual act itself.[1]

  • The researchers found that most cases of sexual misconduct involved a combination of five factors: male physicians (100%), older than the age of 39 (92%), who were not board certified (70%), practicing in nonacademic settings (94%) where they always examined patients alone (85%).[1]

  • In the same study, the researchers found that almost all cases involved repeated abuse (96%) of multiple victims that continued for more than a year (73%), a fact that researchers found to be consistent with earlier studies indicating that a very strong predictor of board sanctions is previous board sanctions.[1]

  • In a cross-sectional analysis of 1039 US physicians reported to the National Practitioner Data Bank for sexual misconduct, researchers found that a greater number of abusers were 40-59 years of age when compared with the general population of physicians, but no other individual traits could be examined, as NPDB's publicly available data do not include gender or medical specialization of abusers. They also found that 87% of victims were female, but they were unable to determine the patients' presenting medical complaints or the types of sexual abuse that occurred.[2]

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