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Observing the boundaries

A number of events in the last few weeks have highlighted that vast array of issues that can effect a doctor’s health and wellbeing. One of those issues in particular is the prevalence of sexual harassment of female GPs.

A national survey of general practitioners’ experiences of patient-initiated aggression in Australia, conducted early in 2010, found that female GPs and GPs with fewer years of experience were the most likely to have experienced sexual harassment.

This is something that I can personally attest to. When I was in my second year as a GP Registrar I did have the uncomfortable occasion to experience a patient’s failure to observe the boundaries of appropriate disrobing. There were also a bevy of married women who visited the surgery far too often with ill-defined problems. The point being that sexual harassment by patients is experienced across our profession, which highlights the need for policies and procedures to prevent it, and skills and strategies to deal with it.

The 2010 survey led to further research focussing on the experiences of female GPs. Of the responding GPs, 54.5 per cent reported experiencing sexual harassment, and almost one in 10 of these reported being sexually harassed more than eight times. The most prevalent behaviours were requests for inappropriate examinations and inappropriate exposure of body parts.

Ensuring a professional relationship with our patients is fundamental to the trust required to care for their health care needs. It is beholden on us to address any behaviour that is unwelcome, and it is equally important that we identify and mitigate any risks to our professional and ethical integrity. The Medical Board of Australia’s Sexual Boundaries: Guidelines for doctors can be useful in this regard.

The impact on GPs of experiencing this sort of behaviour – beyond any sort of physical assault – might be poor morale, absenteeism, stress, feelings of decreased competence or anxiety, substance abuse, and loss of job satisfaction.

It is important that GPs are provided with the necessary training and skills to take appropriate action and manage the situation.  Equally important is that there is culture within the practice that enables such issues to be brought to the fore.

If a GP is experiencing any patient-initiated sexual harassment or any other inappropriate behaviour, doing nothing is not an option. There are a range of options at your disposal. You can speak up. Tell the patient their behaviour is not acceptable. You may wish to consider getting the patient to sign an acceptable behaviour agreement. Seek advice from your colleagues, your employer, or your professional organisation. Make use of a chaperone. Reassess your consulting style. Change your behaviour. The research indicated that, as a result of experiencing sexual harassment by a patient, two-thirds of female GPs made personal changes or changes to their consulting style. Develop strategies for exiting an uncomfortable situation. If warranted, consider discontinuing care of the patient.

The research is also a reminder to practice owners to have policies and measures in place for dealing with instances of sexual harassment. The practice must have a culture that encourages those feeling harassed to speak up. In addition, as the researchers propose, workforce safety training should cover possible sexual harassment by patients.

Practices, as employers, have an obligation under occupational health and safety laws to inform, instruct, train and supervise all employees, both clinical and non-clinical staff, to ensure their safety and to mitigate any risks to their health, safety and welfare.

Training is an ongoing responsibility. The practice should have appropriate induction policies in place, and everyone in the practice should be kept up to date with safety policies and procedures on a regular basis.

There may not have been such training and policies in place when I was a young GP, but in recent years associations such as the AMA have provided a range of resources to assist practices deal with such issues.