T

he first time I heard about a doctor raping a patient was during my third year of medical school. It was a Friday night and I was taking calls coming in to the Boston Area Rape Crisis Center hotline. The woman on the other end of the phone spoke hesitantly at first, explaining that she was “having trouble sleeping.” Then her story tumbled out, her voice cracking with sobs under the weight of profound trauma.

Emily (not her real name) was raped by her surgeon 30 years ago after a routine hernia repair. She had avoided medical care ever since. That Friday afternoon, giving into her aging body’s needs, she had bitten the proverbial bullet and stepped into a doctor’s office for the first time since her rape. That simple act forced her to relive that traumatizing experience.

Doctor’s offices, with their cold, sterile exam rooms and flimsy patient gowns that expose both bodies and vulnerability, are uncomfortable spaces for most of us, seemingly the antithesis of sex. But I was shocked to learn that they could both trigger memories of rape and be the actual venues of it.

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The medical field, like popular culture, reinforces the physician-as-hero trope. Having answered their “life’s calling,” physicians are trustworthy, objective, selfless — even godlike. Doctors certainly do not rape, assault, or molest their patients.

But they do. The harrowing experiences of several hundred gymnasts who exposed Dr. Larry Nassar’s history of molestation under the guise of medical treatment demonstrates how he was able to sexually assault these young women because he was a doctor — using his trusted position and the safe confines of a doctor’s exam room.

Other doctors enabled Nassar’s predatory behavior. There was Dr. Gary Stollak, a clinical psychologist who heard about Nassar’s abuse from a former victim 14 years ago but did not report it; Dr. William Strampel, dean of the Michigan State University College of Osteopathic Medicine, who imposed protocols for Nassar — including wearing gloves and having a chaperone for sensitive exams — but failed to enforce them; and Dr. Brooke Lemmen, who resigned from Michigan State after failing to tell the university that Nassar had informed her he was under investigation by USA Gymnastics.

I’m a physician now. The outrage I felt hearing these stories was accompanied by flashbacks to conversations with survivors like Emily. Sadly, women like her had not been able to garner national attention to punish the physicians who sexually violated them and the other health care professionals who were complicit in these heinous acts.

And they are not alone. An Atlanta Journal-Constitution investigation in 2016 identified more than 2,400 cases of doctors across the country who had sexually assaulted their patients. The investigation found that half of these physicians were still licensed to practice medicine. One pediatrician assaulted as many as 1,000 young patients before being sent to prison.

The medical profession has failed these victims, too. Hospitals ignored reports of sexual assaults and encouraged offending physicians to resign rather than reporting them to medical boards or law enforcement. State medical boards aren’t always a good solution — they are often run by physicians who support their peers without oversight from nonphysician members to help ensure independent accountability.

Physicians’ disciplinary records are not always posted publically. And when they are, they commonly fail to describe the serious nature of sexual assault, using vague language like “boundary violation” or “unprofessional conduct.” In one case, a male physician who purposely did not wear gloves while conducting a rectal and vaginal exam of a female patient was reported for an “infection-control violation.”

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Physicians, hospitals, and state medical boards can and should do more to protect patients from sexual assault. On a daily basis, patients allow doctors to invade their privacy, whether by placing a stethoscope on a naked chest, palpating a mass on a breast, or conducting a testicular exam. This should come with awareness of our privileged role and the incredible responsibility we have to uphold our pledge to “do no harm.”

We must confront the culture of medicine that dissuades physicians from reporting our colleague’s “bad behavior,” including conduct much less egregious than sexual assault. We must also advocate for independence in systems that hold physicians accountable.

At the same time, we must be respectful of survivors of sexual assault by strengthening our training around caring for them and ensuring that they feel comfortable seeking care in an environment that may have previously betrayed their trust. Whether or not the sexual abuse was committed by a physician, many practices and procedures performed in medical offices like gynecological exams — or even the removal of clothing — can trigger a post-traumatic reaction in a survivor of sexual assault. Health care providers should be equipped to offer support in these cases, acting as trauma-sensitive, trauma-responsive, and trauma-informed providers.

But as Olympic gold medalist Aly Raisman said in her victim’s statement, “Talk is cheap.” I hope we can heed her words, and that our collective outrage over Nassar’s conduct leads to instrumental changes in the health care profession.

Altaf Saadi, M.D. is a first-year fellow at the National Clinical Scholars Program at UCLA.

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  • The president of MSU resigned under pressure. As far as I know she was not directly involved in the investigation of Nassar but she was prevailed upon to resign apparently because she seemed to have an indifferent or “philosophical” attitude toward the situation, like “It’s not my problem,” or “These things happen.” Offenders are able to commit their crimes for a long time partly because of people with this kind of attitude.

    • “with strong support from the medical community.”

      It’s good to laugh at least once a day. The medical lobby is influential in state capitals and Washington DC, and they generally oppose measures that they see as an encroachment of the physician’s independence and autonomy.

  • The medical profession has an unwritten “code of silence,” similar to that of the Chicago Police Dept., which mandates that you don’t speak ill of another physician. The few who don’t think that’s right are concerned about being shunned or ostracized by the other physicians. The Japanese have a saying that the nail that sticks up gets hit, i.e. you are supposed to conform to the norms of your group.

  • When Nassar was investigated by MSU they consulted with three doctors who said his conduct was proper. Apparently they were unwilling to criticize Nassar or raise questions about what he was doing. When people become doctors somewhere along the way they are replaced by alien pod people with no sense of right and wrong. It is quite remarkable to watch these educated, amoral beings in action.

  • Dr. Saadi mentioned an article in the Atlanta Journal-Constitution. News organizations in the U.S. have run stories like this for a long time and nothing changes. The medical profession is not bothered by the negative publicity, not to mention the harm done to patients by dysfunctional doctors.

  • I applaud Dr. Saadi for taking a public, moral stand, but I am pretty sure she is going to end up sadly disappointed. The leadership of the medical profession, including medical school faculties, state medical boards, the American Medical Association and so on, are indifferent to these issues, as are the majority of practicing physicians. To them protecting physicians is a higher priority than the patient’s well being. There are a few physicians who disagree with this, and fewer still who are willing to speak out, but they’re like Veronica Cartwright in Invasion of the Body Snatchers – they’re totally outnumbered.

  • Over 65 years ago my 5 year old sister was sexually abused by a doctor. Horrifying. My mother complained to the medical director who told my mother that children make these things up! My mother knew this was not fabricated. She never told our Dad.
    Family secret . Never dealt with on a psychological level by the victim. Totally repressed until watching the Phil Donahue show in the 70s.

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