FSMB toughens sexual boundaries policy
FSMB toughens sexual boundaries policy
Scope of misconduct, disciplinary procedures change
The Federation of State Medical Boards (FSMB) plans to revise the sexual boundaries policy used by state medical boards in determining sexual boundary violations by physicians. The federation began offering an on-line course on sexual boundaries and violations in January for use by medical board officers, and will present a beefed-up version of its sexual boundaries policy at its annual meeting in April.
According to the federation, an association of 70 medical boards in the United States, state medical boards took action on 242 sexual abuse or misconduct cases against physicians in 2004, up from 216 in 2000.
As drafted, the rewrite of the federation’s sexual boundaries guidelines, first issued in 1996, propose expanding the scope of sexual misconduct to include third parties, not just patients, and would be more comprehensive in addressing discipline and physician evaluation.
Misconduct: Sexual impropriety, violation
The federation recognizes two types of professional sexual misconduct: sexual impropriety and sexual violation. Both types are the basis for disciplinary action by the physician’s state medical board if the board finds that the physician’s behavior exploited the physician-patient relationship.
Sexual impropriety includes behavior, gestures, or expressions that are "seductive, sexually suggestive, disrespectful of patient privacy or sexually demeaning to a patient," according to the federation.
The definitions of sexual impropriety, according to the proposed new guidelines, may include, but are not limited to:
- Neglecting to use disrobing or draping practices that respect the patient’s privacy, including watching the patient dress or undress;
- Subjecting the patient to an intimate examination in the presence of medical students or other parties without the patient’s informed consent;
- Examination or touching of genitals without the use of gloves;
- Inappropriate comments about or to the patient, including making sexual comments about the patient’s body or underclothes, making sexualized or sexually demeaning comments to a patient, criticizing the patient’s sexual orientation, or making comments about potential sexual performance during an examination;
- Using the physician-patient relationship to solicit a date or romantic relationship;
- Initiation by the physician of conversation regarding the physician’s sexual problems, preferences or fantasies;
- Performing an intimate examination or consultation without clinical justification and without explaining to the patient the need for it, except when the examination or consultation is pertinent to the issue of sexual function or dysfunction;
- Requesting details of sexual history or sexual likes or dislikes when not clinically indicated for the type of examination or consultation.
Sexual violation may include physical sexual contact between a physician and patient, whether or not initiated by the patient, and engaging in any conduct with a patient or the patient’s surrogate (parent, spouse or other person designated by the patient to made decisions for him or her) that is sexual or may be reasonably interpreted as sexual.
Sexual violation includes, but is not limited to:
- Sexual intercourse, genital to genital contact;
- Oral to genital contact;
- Oral to anal contact, genital to anal contact;
- Kissing in a romantic or sexual manner;
- Touching breasts, genitals or any sexualized body part for any purpose other than appropriate examination or treatment, or where the patient has refused or has withdrawn consent;
- Encouraging the patient to masturbate in the presence of the physician or masturbation by the physician while the patient is present;
- Offering to provide practice-related services, such as drugs, in exchange for sexual favors.
Individual state medical boards, as well, are adopting new policies on sexual misconduct, or retooling existing ones. Among those taking recent action to discourage sexual misconduct by physicians are Washington (forbids all physicians from dating patients); Texas (gives priority to complaints of sexual misconduct); and California (sex offenders are not allowed to practice medicine in that state).
The Federation of State Medical Boards (FSMB) plans to revise the sexual boundaries policy used by state medical boards in determining sexual boundary violations by physicians.Subscribe Now for Access
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