At Mayo Clinic last year, a male patient groped a female doctor in the presence of several other staff members. She immediately notified hospital administrators using a new reporting system, and the patient was terminated from the physician’s practice within 48 hours.
Before this reporting process was created in 2017, the renowned Rochester, Minn., hospital had no procedures for how to deal with patients who harass staff — or even language addressing the issue in hospital guidelines.
The patient’s “behavior was egregious,” but if the incident occurred before 2017 and the physician “complained about it, the patient would have reported her,” said Dr. Sharonne Hayes, a cardiologist and medical director of the hospital’s Office of Diversity and Inclusion, who helped create the new policies. “Now our employees feel much more confident about their role in sexual harassment incidents, what they should and should not do, and that Mayo has their back.”
Mayo’s program — and similar initiatives at other hospitals — reflects growing awareness that it’s not just bosses and colleagues who sexually harass health care workers. Often, it’s the patients who are doing the harassing.
More often, in fact, according to a survey last year by Medscape. Of more than 6,000 doctors surveyed, 27% reported sexual harassment by patients within the past three years, whereas only 7% reported harassment from clinicians, medical personnel, or administrators. The majority of those who experienced incidents were women. Another survey of 822 doctors, conducted by STAT and Medscape in 2017, found that almost 60% had to deal with offensive remarks from a patient over the previous five years.
Yet only recently have hospitals begun grappling with the problem. “Most health care programs had 20 policies in place that protect patients, but not one that had a policy to protect staff from patients,” said Hayes, who also is a founder of Time’s Up Healthcare, a nonprofit launched this year to tackle harassment and gender bias.
The new program at Mayo includes a policy to address patient behavior, a reporting structure for providers to use following incidents, protocols for dealing with patients who behave improperly, and training for staff and students.
Hayes said that more and more hospitals are adopting similar policies to combat harassment by patients, driven in part by concern about skyrocketing rates of physician burnout and mental illness, particularly in women. “These two issues often result from the accumulation of multiple factors including stress, anxiety, and a loss of control of one’s work and environment. Since harassment contributes to all of these factors, I have no doubt that being harassed or poorly treated by patients is additive to all the other challenges faced by doctors, nurses and other members of the health care team.”
In the absence of hospital policies, doctors can find it difficult to deal with patients who act inappropriately toward them. They try to empathize with patients who may feel angry, frustrated, or powerless when interacting with the sometimes inefficient and bureaucratic health care system. They know patients are often stressed and frightened, and most physicians feel they have a duty to provide care, even when patients are difficult. So when doctors feel harassed, they often just laugh it off in an attempt to diffuse the situation and avoid offending the patient.
They may also not want to risk a patient complaint to hospital administrators, or a poor rating on customer satisfaction surveys or online review sites. Doctors also worry that reporting such incidents to colleagues could result in embarrassment, or at the very least, an awkward encounter with the patient on morning rounds.
Dr. Elizabeth Viglianti, an associate professor in pulmonary and critical care at the University of Michigan, said that when she asks other providers about sexual harassment and discrimination from patients, she commonly gets the reply, “It’s just part of the job.”
She recalled an encounter a couple years ago with a male patient who was verbally harassing her when they were alone in the clinic. She felt uncomfortable and unsafe, but later, when she went to her fellowship director and hospital administration, she was surprised to find that no system existed to report and deal with these incidents in an adequate and confidential manner. She said, “We didn’t know where to go next.”
That experience motivated her to create an algorithm in August 2018 to guide doctors and medical trainees at her hospital when they experience harassment or discrimination. It instructs doctors that if the harassment continues, they should transfer the patient to another provider and consider placing a warning in the patient’s medical chart, visible only to providers.
Viglianti said progress is slow, as there still is no reporting system in place for harassment events by patients. But the hospital is now working on a policy to change the patient bill of rights to address issues of sexual harassment by patients.
No one should have to put up with this kind of behavior. On the patients’ side: I am SICK of healthcare providers who treat me worse than their pet dog or cat: there is no eye contact, no smiles, not one word of caring, and they bark orders at me like I was in boot camp. Oh, AND they act like I am totally stupid. After the first five minutes of this type of ‘treatment’ — well, I go to the doctor ONLY when I absolutely have to do so. Perhaps I should mention that I am a senior citizen, and a lot of peers feel the same way.
As a retired ARNP, before my nurse practitioner days, I did hospital staff nursing. We often were groped or assaulted in various ways. We used to chalk it up to mental status changes due to drugs or hypoxia, or dementia. We used to help each other with ways to cope or keep each other safe. During those days most R.N.’s were white women! I see the M.D. role as somewhat different, have to think about how. My dignified father pinched health care staff when towards the end of his life and he had severe vascular dementia.
The elephant in the room is who’s doing this? What was this clients name? Some cultures allow or encourage this.
I worked in a long term care facility that had a cluster of old alcoholics with dementia. Sexual harassment of the female nursing staff was chronic. Their activity therapist (who was gorgeous and often a victim of harassment) took the initiative and set up a behavior modification program. It was “Happy Hour”. Once a week they would load them up in the activity bus and roll them into a nearby bar. Served them non alcoholic beer and they had a jolly old time for a couple of hours. BUT if they were inappropriate with the staff, they got grounded that week. No Happy Hour if they were inappropriate with the staff. The frequency of staff harassment went down dramatically.
The general rule is that only patients’ medical information should be charted. Accordingly, be careful when entering nonmedical information into patients’ charts; you may be at risk for a defamation claim!
Considering a patient’s observable behavior as part of an assessment that includes mental status, in a matter-of-fact reporting of his/her condition, doesn’t fit the definition of defamation. This is especially important if a family member or friend reports that this is unusual or is limited to a period of time or specific situations. Accurate diagnosis and treatment depend on accurate data. HIPAA protections limit access to such information, as well.
Doctors will have all my sympathy when patient harassment is the third leading cause of doctor deaths.
Until then, let them practice medicine more responsibly.
According to NPR.org, avoidable hospital errors are the third-leading cause of death in hospitals, after heart disease and cancer.
The only thing worse than not treating kidney disease or diabetes is treating kidney disease and diabetes.
Actually killing patients makes these sob stories look kind of trivial.
Feeling “uncomfortable and unsafe” seems like a petty complaint compared to feeling agony and death.
What would you choose for your loved one — “Offensive remarks” or Preventable fatal medical error”?
And that’s not even factoring in that most of these episodes are committed by patients with cognitive failures of various kinds.
It’s a ridiculous premise for an article — just a reporter desperate to get published by whipping up a fake problem.
Don’t you think that a more compelling story would be the devastating kill ratio of helpless and trusting patients by doctors and nurses — completely unnecessary and avoidable?
Hi, Audry ~
Here’s the link to the NPR report
https://www.npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors
Hasty generalization fallacy. Did you bother to read and evaluate the actual study? Or do you just regurgitate what a media outlet reports? Thanks for playing.
Hi, James ~
I take it you are claiming that preventable medical error is NOT the third-leading cause of death?
And you have decided this because you can evaluate the data more accurately than Johns Hopkins, right?
Or maybe citing a Johns Hopkins report is just regurgitating news reports?
But I don’t blame you really.
I also had a hard time accepting this.
But you had better grow up about it.
This slaughter of 250,000 to 400,000 patients per year is coming to you and yours.
Your parents, siblings, grandparents, wife, and children … and you … are all going to be exposed to this preventable catastrophic medical “care,” whether you admit it or not.
Say, I just realized — you’re just a shill for the medical profession.
A .gov site
Medical error—the third leading cause of death in the US.
https://psnet.ahrq.gov/resources/resource/30007/Medical-error-the-third-leading-cause-of-death-in-the-US
Another .gov site
Medical error-the third leading cause of death in the US.
https://www.ncbi.nlm.nih.gov/pubmed/27143499
A .org web site
Medical Errors Are No. 3 Cause Of U.S Deaths, Researchers Say
https://www.npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors
https://www.bmj.com/content/353/bmj.i2139
https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html
The Third Rail: Medical Error as a Leading Cause of Death
https://www.physiciansweekly.com/the-third-rail-medical-error-as-a-leading-cause-of-death/
https://www.usnews.com/news/articles/2016-05-03/medical-errors-are-third-leading-cause-of-death-in-the-us
Medical errors are third-leading cause of death in the US
https://www.statnews.com/2016/05/03/medical-errors-death/
Here’s an article from Science-Based Medicine poo-pooing the Johns Hopkins report
https://sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s-2019-edition/
Anna, why does it have to be an either-or situation?
No one is suggesting that the rate of medical errors is acceptable, yet your comments seem to suggest that sexual harassment and abuse of medical personnel by patients should be acceptable, perhaps even expected, with no recourse or refuge available to said personnel. Not all doctor/ nurse/ other medical support staff that experience such inappropriate behavior do so while seeing patients with dementia. Plenty of patients perpetrating such actions are in full control of their mental faculties.
I’m short on time, but I have a legitimate question that I don’t currently have an answer to. While your statistic that 1/3 of deaths have some sort of medical error as a contributing factor is indeed appalling, I wonder how those deaths are represented in terms of percentage of the population? Because a relatively small percentage of the population dies over any given time frame, then only 1/3 of that percentage is the number I’m looking for.
How does that number (the percentage) compare to the percentage of healthcare providers who have experienced sexual abuse and/or harassment?
While I think it’s critical that verbal and physical sexual harassment, as well as realistic violence risk, be recognized and addressed in medical and nursing settings, I also believe that it’s a vital to recognize when patients may have altered mental status and assess the behavior in that context. Those whose behavior is influenced by open or closed TBI — including neurosurgery — dementia, acute exacerbation of a mental illness, alcohol or substance intoxication/withdrawal, also need medical/nursing care. Those who provide that care should be trained in best practices to deal with/deflect/defuse behavior that results from a clinical condition— as opposed to personality disorder, entitlement, or a lifelong pattern of ingrained behavior. The care setting should also recognize that systems for greater security may be needed and reliably available when situations become high risk. Both patients and employees at all levels have been poorly served when there’s no training provided for appropriate, calm, limit-setting or re-directing responses to inappropriate words or actions, no room to include behavioral assessment and reporting, and no training on basic risk assessment — especially when a clinical condition is or may be the source of the behavior. Clinicians need to know how to recognize, assess, and document disinhibition vs. reportable harassment. The current system is unfair to both personnel and patients.
Thanks for this excellent and erudite comment.
Your answer is far better than the article, which was apparently not even edited.
And congratulations for knowing how to spell “defuse.”
You wrote:
> “Those who provide that care should be trained in best practices to deal with/deflect/defuse behavior that results from a clinical condition … ”
but the OP wrote
> “So when doctors feel harassed, they often just laugh it off in an attempt to diffuse the situation and avoid offending the patient.”
While working at a long term care center as a RN I had a terrible time with one specific male patient who loved sharing stories of his sexual escapades when he was a young man overseas during the war and let me tell you he was very explicit! He would even tell me what he liked to eat…all the time.. uh huh! I told him he made me feel very uncomfortable when he repeatedly told me these stories and I tried to be mindful of his cognition but it didn’t matter he continued. I finally went to my supervisor and her reply was “Oh I know ha ha ha he’s been in here a few times and he’s always like that.” I was shocked by her response but I knew she couldn’t have him thrown out of the facility and they blamed it on his mental state! This was in 2012.
I just noticed the comment before mine and it speaks about the problem in nursing homes due to dementia etc. I know they are sometimes not in their right mind it doesn’t make it any easier.
I almost forgot.. after continued stories my supervisor switched me out of his assignment and when he came back in for rehabilitive care they all knew I was not going on his room, it wasn’t a problem with the other girls they understood. Thanks
While providing a surgery consult a wealthy patient groped me. It happened in front of his family and the hospital’s foundation donor recruiter. No one stopped him, or reprimanded him. It was all about sucking up to the patient and his family’s money. I refused to see the patient again.
That makes me sick it always upset me when I had a doctor come in and tell me that so and so was on the schedule and they were a board member so take good care of them. I get it that he was giving me a heads up but each time he informed me of such a pt my reply was “I treat every patient liked they are my family” it pissed me off that did he think I was going to do when I didn’t their exam? Come on now.
Sexual harassment is an issue throughout the medical profession. It is both worst and most difficult to address in nursing home patients with dementia. Nurses, CNAs, phlebotomists, and home health aides have to deal with salacious comments, ass-grabbing, and even being urinated upon. These are personnel who cannot decline patients.