Preventing Sexual Abuse and Misconduct in the Medical Practice

Physicians, Advanced Practice Providers (APPs), and other clinicians must be proactive about preventing sexual abuse and misconduct in the medical practice. It is an abuse of power and a violation of patients’ trust, and it is the health care professional’s responsibility to avoid improper behavior.  

How often does sexual abuse or misconduct actually happen in medical practice? Since the days of Hippocrates, it has been forbidden for physicians to interact with patients in a sexual manner, yet published accounts of sexual misconduct indicate that between 0.1% and 9% of physicians and APPs have had some sort of sexual encounter with a patient. The occurrence rate may be even higher, since patients are often reluctant to report misconduct.  

• • National Practitioner Data Bank records show 1,721 adverse actions taken against physicians for sexual misconduct between 2000 and 2019¹; an average of 86 physicians, or 0.01% of licensed physicians, per year.
    
    
  • In a 1996 anonymous survey of AMA members, 3.4% reported a history of personal physical sexual contact with one or more patients²,
    
    
  • An older survey of self-reporting family practitioners, internists, obstetrician-gynecologists, and surgeons found the rate to be 9%³.  

With a problem this longstanding, what can medical practices do to protect their patients?  

The MICA Risk Team recommends implementing policies and procedures designed to prevent misconduct and limit related allegations. This article presents several policies your practice can implement to keep staff educated and informed as part of an overall compliance program. 

Policies and Procedures 

Practices should consider implementing policies and procedures designed to prevent misconduct and limit related allegations. Clinicians and staff should be trained to follow policies relevant to their duties such as: 

• • Recognizing improper behavior;
    
    
  • Performing background checks;
    
    
  • Maintaining appropriate professional boundaries;
    
    
  • Obtaining consent for sensitive examinations;
    
    
  • Interacting professionally during sensitive examinations and explicit discussions;
    
    
  • Using chaperones; and
    
    
  • Reporting sexual abuse and misconduct. 

Recognize Improper Behavior 

The first and simplest step toward prevention is to ensure that staff members recognize the wide range of behaviors that constitute sexual abuse and misconduct. Sexual abuse includes physical sexual contact between a clinician and a patient, consensual or not. Sexual misconduct includes any behavior that a patient may reasonably interpret as sexual, such as sexually demeaning or suggestive language, sexual gestures or body language, and disregard for patient privacy. Regardless of how an interaction begins, it is the clinician’s responsibility to recognize the impropriety and stop the behavior.  

Perform Background Checks 

When medical practices consider hiring someone who will be interacting with patients, they should conduct thorough background checks. In addition to confirming that the physician, APP, or staff member does have their stated education, training, and experience, background checks will provide a snapshot of the applicant’s past. Criminal records, professional board disciplinary actions, and employment reference checks may reveal a prior history of misconduct or impropriety. That knowledge gives the practice the opportunity to exclude the individual , thus protecting itself and its patients. 

Maintain Appropriate Boundaries 

People set boundaries based on individual situations. In the medical field it can be difficult to set boundaries due to the close trust relationship that exists between clinicians and patients. At the same time, maintaining appropriate boundaries is essential to avoiding impropriety. If a clinician examines a patient in a casual environment outside the clinic, such as in a home, it could blur professional boundaries. Casual relationships where suggestive humor, provocative language, and suggestive body language are used are always outside the boundaries of a provider-patient relationship. These behaviors can easily be misconstrued, making the patient and the clinician uncomfortable.  

Obtain consent from the patient before examination 

Health care professionals should ensure their patient’s understanding of the physical examination before performing it. When you provide an opportunity for the patient to ask questions, raise concerns, or decline the examination, you may prevent allegations of improper sexual contact.  

Explain details and address any questions, and perform the exam only after the patient provides consent. Conduct the examination with the patient draped in order to minimize the patient’s exposure and maintain their dignity. Use the minimum amount of physical contact required to make a diagnosis and plan treatment. When a patient does not understand what is happening during an examination physical contact may cause discomfort, and the patient could file a sexual misconduct complaint. 

Use chaperones 

Using chaperones provides reassurance to patients as well as physicians and APP’s. Chaperones should be present for all sensitive exams, regardless of patient or clinician gender. 

Chaperones may serve several purposes, including: 

• • Promoting feelings of comfort and safety for patients and clinicians;
    
    
  • Reassuring patients about the professional nature of physical exams;
    
    
  • Reducing the risk of misunderstandings between patients and clinicians; and
    
    
  • Providing physicians and APPs with protection against unfounded allegations of improper behavior. 

Chaperones provide protection to the practice when used properly. It is strongly recommended  to have a chaperone present during any patient examination involving the breast, genital or rectal areas of a patient of a different sex. In today’s environment, physicians may want to consider a chaperone for all patients, regardless of sex. 

According to MICA’s article, The Use of Chaperones During Physical Exams, “Chaperone policies protect patients and clinicians alike and can promote trust and confidence. If your practice hasn’t yet adopted a chaperone policy, or if your current one needs updating, MICA’s Risk Team can help. To get you started, this article, offers recommendations about what to include in an effective chaperone policy, lists steps clinicians can take during sensitive exams to reduce the risk of misconduct allegations, and provides a link to a sample policy like the one adopted by the Arizona Osteopathic Board.”⁴ 

Implement Clear Reporting Guidelines 

Medical practices should develop and implement clear policies aimed at preventing the occurrence of improper behavior. Clinicians and staff have an ethical and legal duty to report misconduct. Practice policies should include a detailed explanation of the reporting process and the proper party(ies) to receive the reports. Staff should understand the process and feel comfortable raising concerns without fear of retaliation.  

Mandated reporting laws require a “reasonable suspicion” or “cause to believe” misconduct has occurred. These laws include protections for the reporter in the event that the investigation concludes there was no impropriety. If it does find there was sexual abuse or misconduct, you may notify law enforcement, and the process will be carried out through the justice system. When a report results in adverse action by the medical board, such as revocation of a licensure, the board is required to report the action to the National Practitioner Data Bank, adding one more method to prevent future misconduct.  

Risk Solutions 

Physicians, advanced practice providers, and  medical practices should objectively consider their interactions with patients and determine where there are opportunities to implement new processes designed to prevent misconduct. A good place to start is to ensure that staff members recognize the wide range of behaviors that constitute sexual abuse and misconduct. Keep lines of communication open as you train and work with staff proactively to protect patients and the practice. 

MICA’s Risk Team is available to answer questions and provide more information and assist with implementing new policies and procedures. You can reach a Consultant Monday – Friday 8am – 5pm Arizona Time at 800-705-0538, 602-808-2137, or rm_info@micainsurance.com. 

^{[1] J Law Biosci; 2022 Mar 29;9(1):lsac007. doi: 10.1093/jlb/lsac007} 

^{[2] Bayer T, Coverdale J, Chiang E. A national survey of physicians’ behaviors regarding sexual contact with patients. South Med J. 1996;89(10):977–982.} 

^{[3] Gartrell NK, Milliken N, Goodson WH 3rd, Thiemann S, Lo B. Physician-patient sexual contact. Prevalence and problems. West J Med. 1992 Aug;157(2):139-43. PMID: 1441462; PMCID: PMC1011231.} 

^{[4] Varner Powell, Jeanne. The Use of Chaperones During Physical Exams. Mutual Insurance Company of Arizona; 2024.}