Sent

Sent: Friday, May 16, 2003 3:22 PM

Subject: Educating Physicians to Prevent Sex-Related Contact With Patients

http://jama.ama-assn.org/cgi/content/full/281/5/419

NOTE: TEXAS HAS DONE NOTHING TO EDUCATE TEXAS PHYSICIANS -- This is about Colorado!

Educating Physicians to Prevent Sex-Related Contact With Patients

To the Editor: In response to the article by Ms Dehlendorf and Dr Wolfe about physicians who have been disciplined for sex-related offenses, it occurred to me that others might be interested in the initiatives undertaken by Colorado physicians to address this problem and other boundary violations.

In 1996, a cooperative program was developed with the Colorado Board of Medical Examiners, the Colorado Physician Health Program, and Copic Insurance Company. This program focuses on the need for better understanding and definition of boundary violations in the physician community, including that of inappropriate sexual behavior with patients. The Colorado Board of Medical Examiners has indicated that this is a major cause of complaints from the patient population. Based on that concern, Copic, the major medical liability insurance carrier for Colorado physicians, and the Colorado Physician Health Program, a not-for-profit independent organization developed by the Colorado Medical Society and the Denver Medical Society to address physical and psychological problems in the physician community, agreed to develop an educational program for Colorado physicians.

After review of the data provided by the Colorado Board of Medical Examiners, the Colorado Medical Society, the Colorado Society for Osteopathic Medicine, and the Colorado Physician Health Program, a psychiatrist with proven experience and clinical competency in managing physician boundary problems was chosen to present a series of seminars for Colorado physicians. The goal is to provide regional seminars throughout the state of Colorado and to serve as a resource for hospital medical staffs as well as other physician organizations who need assistance in managing this group of problems. At present, 6 seminars on sexual boundary misconduct, bartering services (eg, physicians trade office visits for tickets to sport events, concerts), self-disclosure issues, physical boundaries, and treatment of self and family have been conducted, attended by 55 physicians at no charge, with extremely positive reviews and exemplary support from the medical community. The Oregon Board of Medical Examiners has asked to review this project. Copic offers premium credit for their insured physicians who participate in the Boundaries Issues Seminar and encourages other medical liability companies to offer similar incentives. The Colorado Physician Health Program staff and Copic Insurance Company risk managers are available to assist other organizations throughout the country that might be interested in developing similar programs.

George O. Thomasson, MD, CPM Copic Insurance Company Englewood, Colo 1. Dehlendorf CE, Wolfe SM. Physicians disciplined for sex-related offenses.

JAMA. 1998;279:1883-1888. ABSTRACT/FULL TEXT

In Reply: The efforts of the Colorado Board of Medical Examiners, the

Colorado Physician Health Program, and Copic Insurance Company to educate

practicing physicians on patient-physician boundary issues, including

inappropriate sexual behavior by physicians, are laudable. The innovative

incentive of malpractice premium credit could be an important means of

expanding the number of physicians whose practice patterns include adequate

knowledge of their responsibilities and power in the patient-physician

relationship and how to avoid abusing this power. It is discouraging that

among state medical boards, only Oregon thus far has requested to review the

Colorado project.

For many physicians participating in these seminars, however, this might be

the first time they have been educated about this serious problem. The

education of future physicians in medical school and residency programs

about

these important boundary issues and about sex-related offenses must be

greatly expanded from the generally anemic effort at present in most

programs.

There should be required classes on the ethics of the patient-physician

relationship, including these issues of sexual behavior for all medical

students and training for all residents. These efforts will reach many more

potential offenders earlier in their careers and thus have the potential to

protect many more future victims. To further emphasize the importance of

these issues, national and state medical licensing examinations and

specialty

board certification examinations must incorporate questions requiring

knowledge of these areas.

The content of such programs designed to address boundary issues, whether in

medical school, residency, or afterward, as in the Colorado program, are

also

of concern. All such programs need to be examined carefully to ensure that

ambiguity is conveyed regarding the ethics of patient-physician

relationships. Furthermore, the perspectives of victims/survivors of sexual

abuse by physicians should be included to communicate the real potential for

harm when physicians cross boundaries.

We encourage all medical boards, medical schools, and residency training

programs as well as medical malpractice insurers to develop programs to

prevent the occurrence of sexually abusive behavior by physicians. In

addition, as we concluded in our article, we recommend that state medical

boards significantly increase the frequency and severity of their

disciplinary actions against those physicians who do commit sex-related

offenses. As a combination of primary prevention, secondary prevention, and

deterrence, these changes have the greatest potential to protect the public

from this most flagrant abuse of the patient-physician relationship.

Christine E. Dehlendorf, BSc

University of Washington School of Medicine

Seattle

Sidney M. Wolfe, MD

Public Citizen's Health Research Group

Washington, DC

Edited by Margaret A. Winker, MD, Deputy Editor, and Phil B. Fontanarosa,

MD,

Interim Co-Editor.

JAMA. 1999;281:419-420.