Schulte H M, Kay J
Department of Psychiatry, Wright State University School of Medicine (WSUSOM), Dayton, OH.
Acad Med. 1994 Oct;69(10):842-6. doi: 10.1097/00001888-199410000-00015.
Sexual behavior in the context of the doctor-patient relationship has potentially devastating effects on health care and the psychological well-being of patients.
To investigate the exposure of medical students to patient-initiated sexual behaviors (defined as any kind of sexual remarks or behaviors directed toward students by patients), 253 third- and fourth-year students and 1992 graduates of Wright State University School of Medicine were surveyed in the summer of 1992. The instrument used was a 16-item self-administered questionnaire, which solicited data on each respondent's age and gender as well as responses to patient-initiated sexual behavior, various aspects of the clinical settings in which such behavior occurred, and the effects of this behavior on the respondent's education and future practice.
Of the 253 students and graduates surveyed, 155 (61%) responded (73 women and 82 men.) Fifty-two (71%) of the women and 24 (29%) of the men reported at least one instance of inappropriate sexual behavior by a patient. Frequently students had encountered inappropriate behavior more than once.
Even assuming that all the nonrespondents had not experienced inappropriate sexual behavior, the proportion of students and graduates who did report such behavior is considerable. Understanding the extent and nature of patient-initiated sexual behavior experienced by physician trainees is hampered by differing definitions of inappropriate sexual behavior, subjective reporting, and variable perceptions of situations dependent on previous experience. Since patient-initiated sexual behavior can cause physicians to distance themselves from their patients and can put patients at risk for sexual exploitation, training in medical school is necessary to help students effectively manage such complex behavior.
医患关系中的性行为可能会对医疗保健和患者的心理健康产生潜在的毁灭性影响。
为了调查医学生遭遇患者主动发起的性行为（定义为患者对学生做出的任何形式的性言论或行为）的情况，1992年夏天对莱特州立大学医学院的253名三、四年级学生和1992名毕业生进行了调查。所使用的工具是一份16项的自填式问卷，该问卷收集了每位受访者的年龄和性别数据，以及关于患者主动发起的性行为、此类行为发生的临床环境的各个方面，以及这种行为对受访者教育和未来行医的影响的回答。
在接受调查的253名学生和毕业生中，155人（61%）做出了回应（73名女性和82名男性）。52名（71%）女性和24名（29%）男性报告至少有一次患者的不当性行为。学生们经常不止一次地遇到不当行为。
即使假设所有未回应者都没有经历过不当性行为，报告此类行为的学生和毕业生比例也相当可观。对不当性行为的不同定义、主观报告以及因以往经历而异的情境认知，阻碍了我们对医学生遭遇患者主动发起的性行为的程度和性质的了解。由于患者主动发起的性行为会导致医生与患者保持距离，并使患者面临性剥削的风险，因此医学院有必要进行培训，以帮助学生有效应对这种复杂行为。
