respectful environment. Staff
members may hesitate to phone
or ask questions if they know from
experience that the doctor is nasty
In the charged #Me Too atmosphere, sexual misconduct is also
the focus of increased scrutiny
regarding physician misconduct.
The important takeaway is that
such misconduct is not limited to
sexual intercourse. It can be a mere
touch directly to any body part and
even through clothes if a reasonable person would construe the
touching to be motivated by a physician’s sexual gratification. It can
also be verbal or nonverbal conduct that would be offensive to a
reasonable person—a comment or
gesture that is unwelcome, creates
a hostile workplace, or is abusive. 2
Social media can contribute to
situations that evolve into acts of
sexual misconduct or harassment.
With increased use of cell phones
(and the Internet) in patient care,
physicians must be vigilant and
not violate boundaries to ensure
messages or photos cannot be
construed as lewd or suggestive.
Additionally, a physician should
not discuss his or her personal
sexual issues with a patient or
coworker. I know of situations
where the doctor/patient relationship was used to solicit a date
or was the basis for prescribing
medications in exchange for sexual
favors. It is incumbent on the
physician not to initiate these inappropriate exchanges and quickly
terminate any such exchanges initiated by others. A physician can be
held liable for participating in such
activities even when he or she is not
the one who initiated the discourse.
Sexual misconduct can also take
place in the context of an examina-
tion. It can happen when performing
an intimate examination or consul-
tation without clinical justification,
not providing privacy or drapes for
a patient, groping in the guise of
an exam, or not using gloves when
examining mucosal areas.
Extremes and Patterns
As with disruptive behavior, sexual
harassment or misconduct are
defined broadly and are not limited
to conduct with a subordinate. It
may be a single extreme act or a
pattern of acts with anyone associated with the delivery or receipt of
In this climate, it often takes only
one egregious act to be labeled a
disruptive physician and engender
action. However, most often it is
a pattern of behavior. Many times,
the disruptive physician is one
who was educated and trained in
a different era when the physician
was a proverbial king or queen, and
behavior was not questioned. In
the present environment, negative
actions do not go unopposed, nor
are they tolerated.
The Joint Commission, as early
as 2008, issued a Sentinel Event
Alert emphasizing that certain
conduct undermines the culture of
safety within a healthcare setting. 3
The alert directed all accredited
healthcare facilities to create a
code of conduct and then establish
a process to manage disruptive
and inappropriate behaviors. It
behooves all healthcare organiza-
tions, including physician groups, to
Reduce Stress to Create
a Safe Workplace
X Identify physician and staff stressors; work to ameliorate their impact
on the workplace.
X Work to improve systems.
X Enhance training for new technologies, especially EMR.
X Improve scheduling.
X Provide additional staff training.
X Reintroduce niceties such as a physician lounge. A cup of coffee goes
a long way—and sandwiches go even further.
X Employ wellness coordinators.
X Provide gym facilities.