Possible to discipline a patient?

[AmoryBlaine]

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Fellow SDNers,

Awhile back I observed a situation that really got me thinking. One of my female colleagues (M3) described to me a very upsetting encounter with a male patient. This guy was fairly young (maybe late 20s), I can't even remember why he was in house but it was nothing to serious. Anyway, she had gone in to do her initial H/P and he told her that she was "fine looking" as he carressed her face.

At first read, it's kind of funny. Then again, it's harrassment. If a doc had done something like this to a female pt the fires of Hell would be brought down on his head. Since the dude actually touched the woman, it strikes me as different than the typical 65 year-old crusty VA patient talking about how pretty his medical student is.

Would the hospital ever have any recourse to discipline such a patient? Assuming he was medically stable could they inform him that he must seek care elsewhere? Could he be barred from further elective admission?

I know in the scheme of things it's not THAT big of deal and most of my female colleagues have probably had some similar experience. But we as medical students have to sit through hours and hours of discussion about "professionalism." Are we allowed to demand that patients hold up their end of the bargain?*

AB



* I realize that in certain settings (ED, psych, etc) a standard of pt behavior could never be enforced. I'm basically asking about non-emergent conditions/situations.

 

[psipsina]

Fellow SDNers,

Awhile back I observed a situation that really got me thinking. One of my female colleagues (M3) described to me a very upsetting encounter with a male patient. This guy was fairly young (maybe late 20s), I can't even remember why he was in house but it was nothing to serious. Anyway, she had gone in to do her initial H/P and he told her that she was "fine looking" as he carressed her face.

At first read, it's kind of funny. Then again, it's harrassment. If a doc had done something like this to a female pt the fires of Hell would be brought down on his head. Since the dude actually touched the woman, it strikes me as different than the typical 65 year-old crusty VA patient talking about how pretty his medical student is.

Would the hospital ever have any recourse to discipline such a patient? Assuming he was medically stable could they inform him that he must seek care elsewhere? Could he be barred from further elective admission?

I know in the scheme of things it's not THAT big of deal and most of my female colleagues have probably had some similar experience. But we as medical students have to sit through hours and hours of discussion about "professionalism." Are we allowed to demand that patients hold up their end of the bargain?*

AB



* I realize that in certain settings (ED, psych, etc) a standard of pt behavior could never be enforced. I'm basically asking about non-emergent conditions/situations.

I believe you could threaten him with security if he can't stop touching you. I think you would present it calmly at first, something like "You touching me is inapropriate for our relationship as doctor and patient, and I'm asking you to stop", and then the next time "If you don't stop touching me I will have to call in security" and so forth, just like the patient was being violent or something else. You don't have to put up with being fondled. If the situation allowed I would also get a male collegue into the room ASAP.

 

[45408]

Would the hospital ever have any recourse to discipline such a patient? Assuming he was medically stable could they inform him that he must seek care elsewhere? Could he be barred from further elective admission?

Sure. More than a few frequent-fliers with foul mouths and violent tendencies have been banned from ERs that I know about. Once a patient is stable, I'm pretty sure that security can escort them from the premises if they refuse an ambulance transport. I'm pretty sure you could also sue for sexual harassment.

 

[lilnoelle]

We had an interesting conversation about this at med school a month ago. One story that was told was of a female obstetrician who had a (near term) pregnant lesbian that developed a crush on her while in the hospital due to abdominal pain and bleeding. She and proceeded to come up with multiple reasons to have this physician (then a resident) do pelvic exams on her. Obviously this was inappropriate. The resident told her attending what was going on and the attending took over for this individual's care.
How a physician handles this will change from physician to physician. Some physicians may decide it isn't worth confronting "harmless flirting" in the VA or other locations. Others will have a "zero tolerance" way of dealing with it and "nip it in the bud" before it becomes a problem.
The concessus was that if it makes the physician uncomfortable it should be dealt with. An important thing to do at that point is have another person in the room when seeing this patient. If it is bad enough, the patient can be transferred to another doctor (although the issue should be talked about with the patient before transferring them).

 

[SupergreenMnM]

I would think that something so minor could be gotten past after a comment to the patient. I don't think this is actually as much of a harrassment issue as a respect for position issue. I've had older female patients do the same thing, but most likely in a very different way, and did not say anything about it.

 

[psipsina]

I would think that something so minor could be gotten past after a comment to the patient. I don't think this is actually as much of a harrassment issue as a respect for position issue. I've had older female patients do the same thing, but most likely in a very different way, and did not say anything about it.

I can see feeling threatened as a female in this type of situation, thats why I suggested bringing a male collegue with you the next time you enter the room. I don't think you would have to go to the calling security level in most instances but I can see it happening, especially if the patient is intoxicated or has mental health issues.

 

[njbmd]

If any patient does anything that makes you feel uncomfortable, your first response is to ask them to stop immediately. Your next response is to step outside and get security/assistance.

Males should never examine a female patient alone and females should never examine a male patient alone. Grab a nurse or a colleague if the door needs to be closed (as it should for an physical exam).

Nothing should take place within the course of the history or physical exam that makes either the examiner or examinee uncomfortable. If this happens, stop immediately and get assistance.

 

[45408]

Males should never examine a female patient alone and females should never examine a male patient alone. Grab a nurse or a colleague if the door needs to be closed (as it should for an physical exam).

This seems rather odd to me. My wife is a nurse, and there are plenty of times when she walks into a male patient's room and she is the only other person in the room. Having a constant escort seems like quite the unnecessary measure.

 

[lilnoelle]

This seems rather odd to me. My wife is a nurse, and there are plenty of times when she walks into a male patient's room and she is the only other person in the room. Having a constant escort seems like quite the unnecessary measure.

The door is probably left open though. I'm guessing that most individuals have the escort in situations where the door needs to be shut like with a pap or rectal exam. I've never had a "female" exam where the doctor did not have a nurse present.

 

[t33sg1rl]

There's a huge difference between being in the room alone with the patient (door open or closed, patient dressed or not) and being in the room alone with the patient, touching their genitals.

I've had rude comments from the crusty old VA type patient, but they all meant well-I think largely they feel these comments are compliments and conversation starters. It makes me uncomfortable, but I would never say anything. Being caressed by a patient, though, would be an immediate dealbreaker. Supergreen, inappropriate touch is never "minor"-have you really been fondled multiple times by older female patients?

 

[SupergreenMnM]

No...the person said the patient touched her face (assumed briefly, unless I misread), not fondeled her somewhere. I have had older female patients do that, but as I said it in no way seemed like they were trying to be sexual (for ex. sometimes w/tears in eyes and saying thank you) but none the less it probably wasn't appropriate. Nothing in the first post was about being fondled, and if I ever felt that something was going on that would make one uncomforable in that way I'd agree with what others posted as to what to do. However, as long as the person doesn't feel it fits that context I don't think it has to be the call security and tackel the old man/woman approach 🙂

 

[psipsina]

No...the person said the patient touched her face (assumed briefly, unless I misread), not fondeled her somewhere. I have had older female patients do that, but as I said it in no way seemed like they were trying to be sexual (for ex. sometimes w/tears in eyes and saying thank you) but none the less it probably wasn't appropriate. Nothing in the first post was about being fondled, and if I ever felt that something was going on that would make one uncomforable in that way I'd agree with what others posted as to what to do. However, as long as the person doesn't feel it fits that context I don't think it has to be the call security and tackel the old man/woman approach 🙂

I think the touch in the OP was upsetting not because of what was being touched (her face) but because it was with a "your so fine" comment. I've had male patients touch my shoulder or my hand and was not put off because the conversation wasn't sexual, but the same motion with a sexual comment would be inappropriate. Its all about context.

 

[Critical Mass]

psi and lilnoelle, I need help with my physical exam skills. Can you both test my peripheral sensation at the same time? I'll like perfectly still, I promise. I'm just having a little bit of a hard time visualizing the L1 dermatome.

Strictly professional, of course...

 

[45408]

The door is probably left open though. I'm guessing that most individuals have the escort in situations where the door needs to be shut like with a pap or rectal exam. I've never had a "female" exam where the doctor did not have a nurse present.

I've had my equipment examined by a woman (nurse prac) with no one else present (I was even a minor at the time - double jeopardy). So every male OB/GYN must have a woman present with him at all times? and vice versa for female urologists?

 

[Winged Scapula]

I've had my equipment examined by a woman (nurse prac) with no one else present (I was even a minor at the time - double jeopardy). So every male OB/GYN must have a woman present with him at all times? and vice versa for female urologists?

It is recommended - for the comfort of the patient, and unfortunately, in this day and age, to protect yourself in the case of claims of inappropriate behavior. Its up to you though.

 

[LadyWolverine]

At first read, it's kind of funny. Then again, it's harrassment.

Harrassment is never funny, nor is it ever "minor." This mentality (that harrassment is something that can be laughed about, or that "it's not such a big deal, so I won't say anything") is part of what allows it to perpetuate in the workplace. Having been the victim of sexual harrassment while at a prior place of employment, I know how humiliating, frustrating, off-putting, uncomfortable, and, in some cases, terrifying it can be. We all have the right to work in an environment where we do not have to feel this way, but it is up to us to enforce the rules when instances do occur. I believe that anybody who feels like they are being sexually harrassed (by superiors, co-workers, or, in this case, clients) can and should speak up about it.

I do agree that such instances should be dealt with on a case-by-case basis, and with plenty of discretion. But if you feel that you are being harrassed, or are uncomfortable, it is both your right and responsibility to speak up and say something. In this case, I would have said something right away to the young man about his actions being inappropriate. If, at that point, he refused to stop, I would alert my superiors, as well as security, if it came to that point. Usually, I think people just need to be reminded that you are a professional, and that they are in a workplace, not a meat market - just like they expect when they are at their own job.

 

[Critical Mass]

I've had my equipment examined by a woman (nurse prac) with no one else present (I was even a minor at the time - double jeopardy). So every male OB/GYN must have a woman present with him at all times? and vice versa for female urologists?

I only allow female urologists. They say that I'm an easy patient. Something about a straighter urethra being easier to examine...

 

[pennybridge]

I only allow female urologists. They say that I'm an easy patient. Something about a straighter urethra being easier to examine...

harrr.

in our ER the only time there's an issue is if its a male physician who needs to do a pelvic, then a female nurse has to be present, or if the ultrasound tech is male, there needs to be a female present if they're doing a trans-vaginal. other than that everything's fair game. I've been double teamed by a female attending and female med student for a below-the-belt exam and I know of two instances where a female attending did digital rectals on male patients alone.

there's probably subtle differences from hospital to hospital, but pretty much the spirit of all the rules is "protect the female patient" and everything else is party time.

 

[da8s0859q]

I believe you could threaten him with security if he can't stop touching you. I think you would present it calmly at first, something like "You touching me is inapropriate for our relationship as doctor and patient, and I'm asking you to stop", and then the next time "If you don't stop touching me I will have to call in security" and so forth, just like the patient was being violent or something else. You don't have to put up with being fondled. If the situation allowed I would also get a male collegue into the room ASAP.

Well, my initial reaction was more along the lines of "Get your ****ing hand off me" - guess I'm not professional.

Or professional but impatient.

Or something.

 

[Tired]

Harassment is a pattern of behavior. It has become vogue to utilize a legalistic definition of it, but that definition is really only applicable in a workplace setting, ie - a coworker engaging in sexually inappropriate behavior or speech. This situation is, in my mind, more appropriately described as sexually inappropriate behavior or even assault (unwanted contact).

My question is why an otherwise intelligent medical student would get close enough to a patient for him to "stroke her face", and once such behavior occurred, why she would not immediately leave the room or tell the patient to stop. I'm guessing that it was the result of shock at the situation, but as others have pointed out here, the onus is on the student in this situation to either leave the room, or if she feels very threatened, call for help.

The other possibility is that the student really wasn't particularly bothered by the situation. I am male, and back in my days as a CNA in a county hospital, was the subject of aggressive homosexual advances on several occassions. One even occurred as I was cleaning a homeless man's diarrhea ("Oh yeah, that's nice. Keep doing that.") Creepy? Hells yeah. Threatening? Not particularly, since I could have broken him in half if I got worried. I put up with it, so it's possible that this student felt the same.

 

[Critical Mass]

harrr.

in our ER the only time there's an issue is if its a male physician who needs to do a pelvic, then a female nurse has to be present, or if the ultrasound tech is male, there needs to be a female present if they're doing a trans-vaginal. other than that everything's fair game. I've been double teamed by a female attending and female med student for a below-the-belt exam and I know of two instances where a female attending did digital rectals on male patients alone.

there's probably subtle differences from hospital to hospital, but pretty much the spirit of all the rules is "protect the female patient" and everything else is party time.

trans-vaginal--why didn't I think of that as an SDN name?

pennybridge, are you M or F? If M, is there a place where I can sign up to get double-teamed by a female attending and female med student? I got a strange notion today that my PSA might be a little bit elevated...

 

[Gimlet]

My question is why an otherwise intelligent medical student would get close enough to a patient for him to "stroke her face"

I'm sure she had to use her stethoscope at some point during the H&P. That pretty much puts you in range for a facial stroking or worse.

 

[crazy_cavalier]

That guy deserves a slap across the face or a knee to the groin... and nobody should hold it against the female doc if she slapped him.

 

[pennybridge]

trans-vaginal--why didn't I think of that as an SDN name?

pennybridge, are you M or F? If M, is there a place where I can sign up to get double-teamed by a female attending and female med student? I got a strange notion today that my PSA might be a little bit elevated...

M, and student health clinics are useful for things other than the pharmacy and free condoms 👍

edit// and "trans-vaginal" is always more fun to say with a spanish accent