Assessment Tools for Sexual Boundaries
The Federation of State Medical Boards regards physician sexual misconduct very strictly, saying that “...misconduct exploits the physician-patient relationship, is a violation of the public trust, and is often known to cause harm, both mentally and physically, to the patient.... This behavior may be verbal or physical, and may include expressions of thoughts and feelings or gestures that are sexual or that reasonably may be construed by a patient or patient’s surrogate as sexual.” 1 Bayer reported in a national survey of physicians’ sexual contact with patients that 4% of the sample had dated patients, 3% had sex with a current patient, 3% had sex with a former patient, and 20% knew of colleagues dating or being intimate with a patient. 2
With this in mind, we are publishing the following self-assessment tools to help raise awareness, encourage self-reflection, and to promote open discussion among physicians about boundaries.
Primary questions to be answered are: 1) Is this discussion or activity a normal, expected part of medical practice? 2) Will engaging in this activity compromise my relationship with this patient? With other patients? With colleagues? With this institution? With the public? 3) Would I want other patients, other professionals, or the public to know that I engage in such activities?
When answering the questions below, try to think about how often some of the things mentioned occur, i.e., seldom, occasionally, routinely or often.
1. How do I feel if certain patients leave my practice, and why do I feel that way?
2. Do I feel that I would like to discontinue treatment with patients that seem ungrateful?
3. Do I avoid terminating the physician-patient relationship with patients who are emotionally dependent on me?
4. Do I favor patients who comply with my recommendations?
5. How do I feel and act towards patients who get an expected treatment outcome but still complain?
6. How do I deal with cultural taboos that conflict with my opinion of effective treatment?
7. Do I spend a disproportionate amount of time thinking about particular patients?
8. Do I inadvertently or advertently[sic], in words, tone or attitude, prevent patients from participating in the decision-making process in relation to their health care?
9. Do I accept inappropriate gifts from patients?
10. Do I seek advice for personal benefit from a patient during a clinical encounter?
11. Do I pay more attention to my personal appearance if I know that I will be seeing a certain patient?
12. Do I seek more personal details than I clinically need to, in order to find out about a patient’s personal life?
13. Do I routinely do favors or make special arrangements for certain patients (i.e., schedule off-hours or off-site appointments, extend usual appointment length, etc.) and why?
14. Do I treat patients differently if I find them physically attractive or important?
15. Do I share my personal problems with patients?
16. Do I have thoughts or fantasize about becoming personally involved with a certain patient?
17. Do I seek social contact with certain patients outside of clinically scheduled visits? If so,why?
18. Do I tell patients personal things about myself in order to impress them and if so,why?
19. Do I feel a sense of excitement or longing when I think of a patient or anticipate her/his visit?
20. When a patient has been seductive with me, do I experience this as a gratifying sign of my own sex appeal?
21. Do I find myself prescribing medication or making diagnoses for my social acquaintances?
22. Do I ask patients to do personal favors for me?
23. Do I undertake business deals with patients?
24. Do I explain what I am about to do before I examine patients or perform an intimate examination?
25. Do I ensure the patient’s comfort and privacy by appropriate draping or by leaving the room when the patient undresses?
26. Do I ensure that the patient is comfortable during intimate procedures and exams?
27. Under appropriate situations, do I ask patients if they would like a third party present at an examination? 3
1 Addressing Sexual Boundaries: Guidelines for State Medical Boards, Federation of State Medical Boards of the US, Inc. 2 Bayer, T., et. al. A National Survey of Physicians’ Behaviors regarding Sexual Contact with Patients. South. Med. J. 89(10) 977-982, 1996) 3 Extracted from the website of The College of Physicians and Surgeons of Ontario.