All alone with a predatory patient

The RACGP has launched a new resource for dealing with sexual harassment and inappropriate behaviour from patients.

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When RACGP president Adjunct Professor Karen Price sat down with other women in general practice five years ago, she found they all had something in common: everyone had either personally experienced or had a colleague who had been intimidated or harassed in the consult room.

A 2013 study in the MJA found that one in every two female GPs in Australia had been sexually harassed by a patient at some point in their career, and 10% of those women had been harassed eight times or more.

“We certainly know of some doctors who’ve been assaulted, and we know the very classic case of a doctor being killed in Noble Park many years ago,” Professor Price told The Medical Republic.

“We know there is danger in our job because we’re vulnerable in our rooms, and we need to have an ability to manage that vulnerability.”

The RACGP is now calling on other colleges, along with health organisations and government, to better protect GPs from patients who may cause them harm.

To get the ball rolling, the GP college has come out with its own resource, a guide on responding to sexual harassment and stalking by patients.

Sexual harassment can be physical or obvious – unwelcome sexual touching, grabbing or kissing – but it can also take on subtler forms like lewd comments, repeated requests to go on a date or a patient asking intrusive questions about the doctor’s private life or body.

“It can all seem so plausible to begin with, you know – it’s a medical condition, [you’re consulting] and all of a sudden, bang, you’re in a situation,” Professor Price said.

Professor Price herself experienced that exact situation early on in her career.

“It’s really challenging, because it sort of sneaks up on you all of a sudden, you know, like ‘oh okay, no,’” she said.

The practice banned that patient, but he managed to slip through on at least one other instance.

“In terms of offensive, classical, premeditated – because it has to be premeditated if you’re doing the rounds – sexual assault, that’s dangerous,” Professor Price said.

Sometimes, given the nature of general practice, it can be less black and white.

“People who are disinhibited through alcohol, or through frontal lobe lesions, or dementia – those are different to people who are sitting there in full control of their faculties, being predatory,” Professor Price said.

“We’ve also heard a whole range of stories in between.”

The bottom line, according to the RACGP guide, is that GPs are not obliged to continue to care for a patient if they’re concerned for their own safety.

However, the practice does have to ensure that patients are not excluded on the grounds of mental illness or disability and ensure that they receive care in an emergency.

If this is in question or there are any concerns regarding the process of discontinuing care, the RACGP advises GPs to contact their medical defence organisation.

It also recommends that the practice communicate to all staff when a patient relationship is discontinued and agree upon the response if the patient calls or attends the practice.

In terms of ensuring physical safety, the RACGP suggests installing duress alarms in consult rooms, designing consult rooms so that the patient is not positioned between the doctor and the exit and ensuring no team member is alone on the premises at any time.

“[It’s also worth] having a practice policy and procedure in place so that it can be clear to everybody that it shouldn’t be dismissed,” Professor Price said.

“Because the last thing [you want] is report it to the practice, practice owners or corporate who you might be working for and they say, ‘oh, you know, don’t worry about that, it’s nothing’.

“It is something and it needs to be brought out into the open.”