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Attention doctorportal newsletter subscribers,

After December 2018, we will be moving elements from the doctorportal newsletter to MJA InSight newsletter and rebranding it to Insight+. If you’d like to continue to receive a newsletter covering the latest on research and perspectives in the medical industry, please subscribe to the Insight+ newsletter here.

As of January 2019, we will no longer be sending out the doctorportal email newsletter. The final issue of this newsletter will be distributed on 13 December 2018. Articles from this issue will be available to view online until 31 December 2018.

‘Sexy nurse’ trial causes outcry


A trial which looked at whether women wearing “mildly erotic nurse costumes” could lure people into getting medical checkups has caused something of a stir in the normally placid world of community health studies.

The study was designed to test the hypothesis that “hedonic stimuli that nudge people towards preventive actions could reduce health disparities”. In order to do that, the researchers from the University of Tokyo hired young women from a temp agency to dress up in “sexually attractive nurse costumes” and accompany a pop-up health check-up service positioned in a Tokyo pinball parlour. They calculated how well the service did at attracting customers, compared with a control setup which had normally-dressed nurses.

Predictably, the health check-up service with added “sexy nurses” attracted more customers, particularly among the socioeconomically disadvantaged, the researchers reported.

“Offering check-up opportunities equipped with ‘tricks’ that nudge people to act might be effective for anyone but is particularly valuable for socially vulnerable people,” the authors conclude, although they caution that “ethical discussions” are needed before considering the use of “erotic stimuli” in such endeavours.

That note of caution did nothing to quell the outrage in letters to the editors of the Journal of Epidemiology and Community Health, which is published by BMJ Journals.

One professor from the University of Tokyo wrote to say that she felt “deeply offended” after reading the paper. “As a Japanese woman and a registered nurse, I found phrases such as ‘young women wearing mildly erotic nurse costumes’ or ‘solicitation by young women wearing sexy nurse costumes’ to be derogatory and disrespectful.” She added that by using such expressions, the authors and journal editors “tacitly accept and capitalize on stereotypes and prejudices against young women and nurses, and assume that readers will share such insulting views as well.”

Another professor, from the Hong Kong Polytechnic of Applied Social Sciences, opined that “seeing an article which encourages the objectification of women being published in this peer-reviewed journal is both shocking and disappointing”. And paediatrician Dr Patrick Ip of the University of Hong Kong wrote of his “major concern on the authors’ unethical design by regarding young women wearing sexy nurse costumes as a form of acceptable behavioural intervention”.

Faced with the barrage of criticism, both the authors and the journal editors were suitably contrite.

“We acknowledge that the intervention involved drew on stereotypes for female nurses, reinforced the objectification of both women and nurses, thus reinforcing gender inequalities,” the authors wrote. “We are deeply sorry for our poor judgement and for the negative impacts of this paper.”

Although they have not retracted the research article, the editors have appended a note to it which says that the journal “condemns the use of sexism, gender and professional stereotypes” for any purpose, including health promotion programs.

“We are conducting an audit of our review process and will put in place measures to ensure that the material we publish condemns sexism, racism and other forms of discrimination.”

You can access the full paper (and letters of outrage) here.

Should you accept gifts from patients?


The festive season is almost upon us. It’s quite possible, even probable, that if you’re a competent and personable doctor, you’ll have patients who’ll want to give you a gift. But should you accept, or are there times when it would be wiser to refuse?

It’s a tricky subject that hasn’t gained the same attention as gifts or monies from pharmaceutical companies. And yet conflicts of interest can be an issue in patient gift-giving as well. One particularly egregious case is that of the Harley Street psychiatrist Peter Rowan, who was struck off in 2011 after accepting a $A2.1 million legacy from a patient, on top of $A260,000 worth of cheques. Explaining its reasons for deregistering the doctor, the fitness-to-practice panel noted that the patient had been given excessive doses of benzodiazepines before her death, and that the large gifts had clouded Rowan’s medical judgement.

Even if you don’t have any patients offering you millions of dollars, you can still find yourself on the receiving end of a gift that is rather more than the traditional box of chocolates. There is little official guidance on the issue. The Medical Board of Australia’s Good Medical Practice – Code of Conduct merely says that doctors should not encourage patients to “give, lend or bequeath money or gifts that will benefit you directly or indirectly”. But individual hospitals or state health services may have their own rules. For example, NSW Health sets a limit on the monetary value of any accepted gift of no more than $75, and stipulates that a gift register should record any gift given to a staff member.

Mostly, patients give gifts to show genuine gratitude, but doctors should be aware of other possible motivations. It could also be to show inappropriate affection, or it could because the patient wants something from you – preferential treatment, or some form of therapy you wouldn’t normally give.

Most would agree that accepting a token gift as an expression of gratitude is acceptable, particularly when refusal could be embarrassing and harmful to the doctor/patient relationship. But if there is any risk that a gift could influence a doctor’s decision-making, or could be perceived as such, the wisest move would be to decline, as gracefully as possible.

If that’s not possible without embarrassment or patient resentment, other solutions may be possible. Cash gifts could be given to charity, for example, or to a hospital fund.

Timing should be taken into consideration as well. Being offered a gift at Christmas time is a time-honoured ritual, but if you were offered something out of the blue at some other time of the year, you might want to be a little more cautious.

The American Medical Association suggests that before accepting a gift, doctors should reflect on whether they’d be comfortable with their colleagues or the general public knowing about it. That seems like a good rule of thumb: if you wouldn’t want anyone finding out about it, it’s probably best to gracefully decline.