The physician-patient interaction can be a strange one. Patients leave their most important possession–themselves–in the hand of strangers. Typically conservative women will bare their naked bodies to physicians. Although rare, the possibility exists for the physician to take advantage of this situation.
In the U.S. “4 percent of the disciplinary order that state medical boards issue against physicians are for sex-related offenses…Seventy two percent of females medical students and twenty nine percent of male medical sudents have been victors of patient initiated sexual behavoir.” I know of patients who slap cute medical assistants’ behind. Physicians and patients can both act inappropriately.
How do physicians establish trust with their patients?
Atul Gawande gives some examples from around the world in Better: A Surgeon’s Notes on Performance.
- Afghanistan: When a male physician examines a female patient, they are separated by an opaque screen with a two-inch circle cut into the screen. “Behind it, the woman is covered from head to toe by her burka. The two do not talk directly to each other. The patient’s young son serves as the go-between.” S
- Iraq: Family members are present in the exam room whenever there is a male physician examining a female patient.
- Venezuela: A nurse chaperone is present any time there is a breast or pelvic exam. The exam will not take place without the presence of the chaperone.
- England: A nurse chaperone is present any time a patient undergoes a breast, pelvic or abdominal exam.
- Ukraine: A nurse chaperone or family member is rarely present in the examine room, but cultural mores help to maintain a professional tone. Patients always address the physician as Dr. ____, and the physician addresses the patient as Mr. or Mrs. _____.
Gawande, Atul (2007) Better: A Surgeon’s Notes on Performance, Metropolitan Books, 288 pages.
Gawande A (2005) “Naked” NEJM, 353:645-648.