SANCTIONS AGAINST SEXUAL ABUSE OF PATIENTS BY DOCTORS - SEX-DIFFERENCES IN ATTITUDES AMONG YOUNG FAMILY PHYSICIANS

Objective: To explore attitudes of new-to-practice certified family ph ysicians in Ontario concerning sanctions against sexual abuse of patie nts by physicians and to assess the importance of concern about accusa tions of sexual abuse in influencing clinical decisions. Design: Quali tative study and cross-sectional survey. Setting: Ontario. Participant s: Focus groups: 34 physicians who completed family medicine residency training between 1984 and 1989 participated in seven focus groups bet ween June and October 1992. Survey: all certificants of the College of Family Physicians of Canada who received certification between 1989 a nd 1991 and were currently practising in Ontario. Of the 564 eligible physicians 395 (184 men and 211 women) responded, for an overall respo nse rate of 70.0%. The response rates among the male and female physic ians were 70.5% and 69.6% respectively. Outcome measures: Physicians' attitudes toward restricting physical examinations done by physicians to same-sex patients, mandatory reporting of sexual impropriety and lo ss of licence in cases of sexual violation, and the perceived importan ce of concern about accusations of sexual abuse as an influence on cli nical decisions. Results: During the focus groups male physicians in p articular expressed concerns about the effect on their practice patter ns of the current climate regarding sexual abuse of patients. Female p hysicians were a less concerned about possible accusations of sexual a buse but expressed concerns regarding possible sexualization of the cl inical encounter by male patients. In the survey equal proportions of men (163 [93.7%]) and women (191 [92.3%]) disagreed with restricting e xaminations to same-sex patients. The women were more likely than the men to agree that all suspected cases of sexual impropriety committed by other physicians should be reported (121 [58.7%] v. 86[50.0%]), whe reas the men were more likely to disagree (48 [27.9%] v. 32 [15.5%]) ( P = 0.008). The women were also more likely than the men to agree that physicians should lose their licence permanently if they were found g uilty of sexual violation (125 [62.2%] v. 73 [43.5%]), whereas the men were more likely to disagree (61 [36.3%] v. 37 [18.4%]) (p < 0.001). Almost half of the men (80 [46.5%]) but only 28 women (14.1%) reported that concerns about accusations of sexual abuse were of importance in their clinical decisions (p < 0.001). Conclusions: Young female famil y physicians practising in Ontario are much more likely than their mal e counterparts to endorse permanent loss of licence for physicians who sexually abuse patients and are significantly less concerned about ac cusations against themselves. Neither sex endorses only same-sex exami nations by physicians. Educational approaches to protect patients whil e ensuring that appropriate care continues to be delivered are essenti al.