PHYSICIAN DISCIPLINE: Sex-Related Offenses On The Rise
Physician discipline for sex-related offenses "is increasing over time and is relatively severe," but a "substantial proportion" of those disciplined are allowed to continue or return to practice, according to a study in today's Journal of the American Medical Association. Co-authors Christine Dehlendorf and Dr. Sidney Wolfe studied "761 physicians disciplined for sex-related offenses from 1981 through 1996," finding an increase in the proportion of all disciplinary orders that were sex-related "from 2.1% in 1989 to 4.4% in 1996." They found that "discipline had not become more severe over time and almost 40% of disciplined physicians were licensed to practice as of March 1997" (Dehlendorf/Wolfe, JAMA, 6/17 issue). The study, conducted by Public Citizen's Health Research Group, found that "[a]s of March 1997, 216 of the offending physicians" who were charged with such offenses as "rape, molestation and trading sexual favors for drugs" were still allowed to practice (Vanderkarn, Washington Times, 6/17). "Forty-four percent had their licenses revoked or surrendered them," while another "10% faced no serious action" (Perlstein, Washington Post, 6/17).
Violation Of Trust
Doctors who have long-standing relationships with patients and "are privy to intimate details of those patients' lives are more likely to turn that knowledge into an unequal power relationship and engage in sexual misconduct," noted Wolfe. As a result, "psychiatrists, OB/GYNs and family practitioners were overrepresented" in the study (Washington Post, 6/17). "The number of disciplinary actions taken against doctors is extraordinarily low compared to estimates by physicians themselves of the real number of sex-related offenses they commit. Many guilty doctors are escaping any sanction at all," wrote the authors (Public Citizen release, 6/17). The study's authors noted that even when physicians resume practice with "chaperons and monitoring ... such measures are ineffective." "One of the problems of probation is that it's nonenforceable," said Wolfe. "Chaperons may not be aware of what is going on, and other physicians may not report offenses," he added (Washington Times, 6/17).
Take The Offensive!
In their report, Wolfe and Dehlendorf recommend the medical disciplinary system as "the first line of defense" in further protecting patients. The authors suggest that regulatory agencies "be given the authority to protect the identities of the victims during investigation of misconduct. Additionally, "state medical boards should require all investigators and board members to receive training in sensitivity to the issues surrounding sex-related offenses." The authors also call on medical professionals and educators as well as legislators to take roles "in addressing this problem." They endorse an Idaho law criminalizing sexual contact between any physician and patient as a model for state medical boards to follow. Physicians can also alter "the pattern of behavior" by reporting their colleagues' sexual misconduct. Finally, the authors encourage patients "to protect themselves by knowing their rights in therapeutic relationships and by filing complaints with their state medical boards" (JAMA, 6/17 issue).
Looks Good, Try This
In an accompanying editorial in today's JAMA, Dr. Regina Benjamin of the American Medical Association's board of trustees and Dr. Douglas Scutchfield of the Center for Health Services Management and Research at the University of Kentucky commend the rise in disciplinary action, but urge better methods of identifying misconduct. They note that state licensing boards are charged with physician discipline. Scutchfield and Benjamin encourage these boards to tightly control issuance and renewal of physician licenses in order "to guard the profession and safeguard the public." In addition, they encourage medical schools to "consider the inclusion of medical ethics in their teaching." They conclude by urging all organizations tangentially related to physician conduct to take the responsibility of "ensuring that physician misconduct ... is identified and dealt with appropriately" (JAMA, 6/17 issue).