You've no doubt seen the salacious headlines. What's behind
the recent spate of sexual misconduct scandals involving
doctors? And what are the Colleges doing about it?
The list of recent infractions
seems interminable. Former Vancouver Medical Association
president, Dr Gabriel Yong, charged with sexual assault
of two teenage patients. Dr Jocelyn Lussier, a pediatrician
in Drummondville, Quebec, was recently found guilty
of sexually assaulting three teenage patients, after
a 16-year-old boy came forward with allegations that
he'd been drugged and molested during a medical examination.
In January, Dr Kevin P White, a popular and successful
rheumatologist in London, ON, lost his licence for posting
pornographic images of himself with a prostitute on
the internet.
Though doctors who abuse patients
aren't common, every year regulatory bodies turn up
a few who've allegedly participated in activities ranging
from the relatively innocuous to the truly unconscionable.
Repercussions can be dire — from hefty fines and
suspensions to licence revocation and criminal proceedings.
So why does it keep happening?
BOUNDARY
CROSSING
The obvious answer is that doctors are human, and crimes
committed by the general population are likely to touch
them too. "Sometimes, you have physicians with personal
problems who get their needs met in the doctor-patient
relationship," explains Dr Barbara Lent, a GP who also
teaches the College of Physicians and Surgeons of Ontario's
boundaries class at the University of Western Ontario.
"And there are also a small number of physicians who
have mental health problems."
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Warning signs of creeping misconduct
Dr Barbara
Lent suggests if you see these signs, it might
be time to seek advice:
•
"If you're thinking about your patient
in a non-professional way — not just how
you're going to sort out their complicated clinical
problems, but the way you might think about a
friend."
•
"If you find that you're treating particular
patients in special ways, offering to break your
usual rules in terms of clinical care or prescribing."
•
"If you look forward to seeing that patient
to an excessive degree."
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For better or worse, society —
and the medical profession — expects more from
physicians. It's right there in the Hippocratic Oath,
and re-inscribed in codes of ethics ever since. But
that said, boundary violations are often the result
of the complex interplay between the physician, the
patient, and the peculiar pressures of the often very
personal doctor-patient relationship.
"We're dealing with people who,
by definition, are somewhat vulnerable and needy," Dr
Lent observes. "They come to see a person to help them,
who has knowledge and skills that they need, and that
creates a power differential. Then, we ask people about
intimate aspects of their lives. That's fundamental
to the work we do, but it creates a situation of increased
risk."
GREY
AREAS & COMPLICATIONS
Of course, not all boundary violations are created equal.
Many people think that dismissal or suspension should
be weighed against the particulars of the case, and
take the effect on the community into account. When
Dr Ian Shiozaki, a rural Ontario GP who had a brief
relationship with a patient nearly lost his licence
last year, his otherwise doctorless community campaigned
vigorously, and successfully, to get him back. Similar,
but more problematic, is the case of Dr Anthony De Luco
of Sault Ste Marie. He had his licence suspended in
January because of an alleged inappropriate examination
of a patient's breasts and buying pills for another
patient with whom he was having an affair. Nevertheless,
his physician-starved community has begun campaigning
for his reinstatement.
While there's no real grey area
there — sexual relationships with patients are
always problematic, says Dr Lent — it's also true
that temptation comes with the territory. "It wouldn't
be surprising if people did have thoughts about some
of their patients," she says. "The problem is when people
begin to act on some of those thoughts."
Dr Lent says the shift from thought
to action is usually not sudden or entirely out-of-the-blue.
"Often, if you look back on a situation where a physician
got into a sexual relationship with a patient, there
were boundary crossings happening in the relationship
before the sexual encounter."
REACTION
VS PREVENTION
The next question is, what are the Colleges doing to
spot these warning signs? A case in BC involving Campbell
River doctor Mark W Stewart, convicted of sexual assault
against female patients between 1969 and 1989, has brought
that province's College under fire. Dr Stewart's patients
filed a lawsuit against the College for being "reckless
and grossly negligent," contending the assaults would
never have taken place had the College investigated
Dr Stewart.
Unusually, the BC Supreme Court
allowed the case to go ahead, and if the judge rules
in favour of the women there will be huge ramifications
for the way doctors are monitored in Canada, putting
the onus on Colleges to prevent abuse.
The issue of consensual sex between
doctors and patients is even dicier. When a physician's
certificate to practise is revoked, it's usually longterm,
about five years. Ontario, for instance, has a mandatory
revocation when a doctor is found to have sexually abused
a patient, a charge that includes consensual sex. But
a recent ruling in Ontario has reinforced Colleges'
and provinces' right to enforce this precept after Dr
Anil Mussani appealed his revocation using the Charter
of Rights and Freedoms following a consensual relationship
with a patient. The court ruled that certification is
a privilege, not a right, and sex between a doctor and
patient (at least a current one) can never be fully
consensual because of the power imbalance.
As Dr Lent puts it, "Patients often
don't know where the boundary is, but we have a professional
responsibility to set one — it's up to us to draw
the line." — Additional
reporting by Gillian Woodford
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