Cohen M, Woodward C A, Ferrier B, Williams A P
Health Services, Faculty of Health Sciences, McMaster University, Hamilton, Ont.
CMAJ. 1995 Jul 15;153(2):169-76.
To explore attitudes of new-to-practice certified family physicians in Ontario concerning sanctions against sexual abuse of patients by physicians and to assess the importance of concern about accusations of sexual abuse in influencing clinical decisions.
Qualitative study and cross-sectional survey.
Ontario.
Focus groups: 34 physicians who completed family medicine residency training between 1984 and 1989 participated in seven focus groups between June and October 1992.
all certificants of the College of Family Physicians of Canada who received certification between 1989 and 1991 and were currently practising in Ontario. Of the 564 eligible physicians 395 (184 men and 211 women) responded, for an overall response rate of 70.0%. The response rates among the male and female physicians were 70.5% and 69.6% respectively.
Physicians' attitudes toward restricting physical examinations done by physicians to same-sex patients, mandatory reporting of sexual impropriety and loss of licence in cases of sexual violation and the perceived importance of concern about accusations of sexual abuse as an influence on clinical decisions.
During the focus groups male physicians in particular expressed concerns about the effect on their practice patterns of the current climate regarding sexual abuse of patients. Female physicians were less concerned about possible accusations of sexual abuse but expressed concerns regarding possible sexualization of the clinical encounter by male patients. In the survey equal proportions of men (163 [93.7%]) and women (191 [92.3%]) disagreed with restricting examinations 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%]), whereas 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 guilty 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).
Young female family physicians practising in Ontario are much more likely than their male counterparts to endorse permanent loss of licence for physicians who sexually abuse patients and are significantly less concerned about accusations against themselves. Neither sex endorses only same-sex examinations by physicians. Educational approaches to protect patients while ensuring that appropriate care continues to be delivered are essential.
探讨安大略省新执业的认证家庭医生对医生性虐待患者行为的制裁态度，并评估对性虐待指控的担忧在影响临床决策方面的重要性。
定性研究和横断面调查。
安大略省。
焦点小组：1984年至1989年间完成家庭医学住院医师培训的34名医生于1992年6月至10月参加了7个焦点小组。
加拿大家庭医生学院所有在1989年至1991年间获得认证且目前在安大略省执业的认证医生。在564名符合条件的医生中，395名（184名男性和211名女性）做出了回应，总体回应率为70.0%。男性和女性医生的回应率分别为70.5%和69.6%。
医生对将医生的体格检查限制为同性患者、强制性报告不当性行为以及性侵犯案件中吊销执照的态度，以及对性虐待指控的担忧作为影响临床决策的重要性的认知。
在焦点小组中，特别是男性医生表达了对当前患者性虐待氛围对其执业模式影响的担忧。女性医生不太担心可能的性虐待指控，但表达了对男性患者可能使临床接触变得性化的担忧。在调查中，相同比例的男性（163名[93.7%]）和女性（191名[92.3%]）不同意将检查限制为同性患者。女性比男性更有可能同意应报告其他医生所有涉嫌不当性行为的案件（121名[58.7%]对86名[50.0%]），而男性更有可能不同意（48名[27.9%]对32名[15.5%]）（p = 0.008）。女性也比男性更有可能同意如果医生被判性侵犯有罪应永久吊销执照（125名[62.2%]对73名[43.5%]），而男性更有可能不同意（61名[36.3%]对37名[18.4%]）（p < 0.001）。几乎一半的男性（80名[46.5%]）但只有28名女性（14.1%）报告称对性虐待指控的担忧在其临床决策中很重要（p < 0.001）。
在安大略省执业的年轻女性家庭医生比男性同行更有可能支持对性虐待患者的医生永久吊销执照，并且对针对自己的指控明显不太担心。两性都不支持仅由医生进行同性检查。在确保继续提供适当护理的同时保护患者的教育方法至关重要。
