Last week, Columbia University and its affiliated hospitals announced a $165 million settlement to 147 patients who accused a male gynecologist of sexual abuse. The recent settlement follows an agreement last year awarding $71.5 million to 79 other patients for misconduct by the same doctor. The physician, Robert Hadden, pleaded guilty in 2016 to abusing 19 women but shockingly served no prison time.
This development is the latest in a string of similar reprehensible cases. The scope of the problem is difficult to ascertain, but it is clear that, though uncommon, such instances are underreported. There is no doubt that the problem of sexual abuse by physicians has always existed, resulting in incalculable harm to victims.
In 2020, the American College of Obstetricians and Gynecologists’ ethics committee published a revised committee opinion on sexual misconduct in health care. The opinion defines what constitutes sexual misconduct: inappropriate communication; performing breast, genital or rectal examinations either unnecessarily or without consent; intimate relations between a treating physician and a patient; and other violations. The ACOG committee correctly states that even a single episode of sexual misconduct is unacceptable.
The most significant and eye-catching change in the new guidelines is the strongly worded recommendation that a chaperone be present for all breast, genital and rectal exams, whether conducted by male or female providers. In the prior version of the opinion, this was an opt-in recommendation, with vaguely defined parameters for implementation. The latest opinion advocates for a chaperone in all cases, with an opt-out available but strongly discouraged. This approach is thought to benefit both patients and caregivers — by providing reassurance of the propriety of the encounter, deterring inappropriate behaviors, preventing misunderstandings and providing a witness to actual events.
The recommendation is based in part on a review of 101 cases of sexual misconduct, in which, among other findings, it was shown that most offending physicians, at 85%, do not routinely employ chaperones.
I have been an OB-GYN for 30 years. I recognize the importance of the problem and the fact that I can think of no better way than chaperoning to protect patients undergoing sensitive exams. The fact that injury can be perpetrated by physicians during these encounters, in violation of the most fundamental tenet of our profession, is abhorrent to me. And yet, the thought that a third party needs to be interposed in the sacred dyad of physician and patient provokes sadness, an emotion I did not experience with any of the other changes that have profoundly altered the way I practice medicine.
If my female primary care doctor were to inform me that a chaperone is now required for my appointment, I would decline. A third person in the room, even while professionally trained and standing quietly in the corner, would alter the personal interaction between my doctor and me. But that’s easy for me to say. The notion that my physician might cause me physical or psychological harm is nearly inconceivable to me.
But this thinking doesn’t apply to female patients undergoing sensitive exams. And what is it that I find objectionable about a third person? It is common for people other than my patient and me to be present in my examination rooms. Sometimes, I require medical staff to assist me with parts of the patient visit. At other times, with the patient’s permission and under my supervision, a student may observe or even conduct the sensitive parts of the exam. Most of my patients generously permit this teaching to take place without it seeming to adversely affect our interaction.
Perhaps what makes me most uncomfortable is the fear that a chaperone will suggest to my patients that they are endangered by being alone in a room with their doctor, that their physician is a person from whom they require protection. In this sense, the new guidelines may erode trust, which is the foundation of the physician-patient relationship.
And yet, the fact is that our patients need a level of protection we have not previously provided. I accept the necessity of having chaperones in my exam room — but I do so with sadness. Sadness that my practice has changed and sadness that my colleagues and I can no longer be relied upon to do no harm to the people who have entrusted themselves to our care.
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ABOUT THE WRITER
Dr. Emmet Hirsch, an OB-GYN, is a clinical professor at the University of Chicago and director of the OB Hospitalist program at NorthShore University HealthSystem in Evanston.
