Trust between a patient and their medical provider is an essential aspect of medical care.
But what happens when that trust is violated?
It was revealed in mid-September that employees at a University of Pittsburgh Medical Center took photos of a patient while they were under anesthesia.
The patient was being treated for a foreign object lodged in their genitals. Numerous people filled the operating room to take photos of the patient using their phones.
It follows another story that broke in early September, which revealed that five nurses in Denver unzipped a body bag to look at a dead patient’s genitals.
Dr. Jack Ende, president of the American College of Physicians, says such extreme examples of improper behavior aren’t typical.
“These are clear violations of ethics,” Ende told Healthline. “These incidents were particularly surprising to me because they were both so blatantly improper, compared to the ethical infraction of discussing patient information in a public place. But in my experience, these behaviors are not part of how doctors and nurses typically behave.”
In his own career, Ende says he’s never encountered the kind of violations that occurred in Denver and Pittsburgh.
“Society grants medicine the privileges of trust and of self-regulation, so as individuals and as members of the medical profession, we must always act with accountability,” he said.
Arthur L. Caplan, PhD, is a professor of bioethics and the founder of the Division of Medical Ethics at the New York University School of Medicine.
He says incidents like what occurred in Denver and Pittsburgh are rare, but they do happen.
“Most doctors have gotten past adolescent behavior,” Caplan told Healthline. “It goes on as it does in academia, the law, the media, but doctors are held to a very high standard, so they must be aware that idiotic behavior will not be tolerated.”
The ethical code
The American Medical Association’s (AMA) Code of Medical Ethics, which acts as a foundational document for physicians in the United States, emphasizes that patients have a right to privacy, respect, courtesy, and dignity.
The code includes a list of nine principles of medical ethics set down by the AMA. The first states that “a physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.”
The second principle calls on physicians to act with professionalism and “strive to report physicians deficient in character or competence.”
In a statement to Healthline, Dr. David O. Barbe, the president of the AMA, said the association wouldn’t tolerate inappropriate behavior from doctors.
“The American Medical Association has zero tolerance for improper physician behavior. The medical profession must represent the highest ethical standards,” he said. “Patients put their trust in physicians and the overwhelming majority of physicians merit that trust. Millions of patient-physician interactions are conducted daily in the United States with courtesy, respect, dignity and privacy. We take evidence of exceptions seriously.”
The role of a chaperone
During an intimate procedure, such as a pelvic exam, the general rule is to have a “chaperone” in the room.
According to the AMA’s code, use of a chaperone can “help prevent misunderstandings between patient and physician.”
The policy states physicians should “always honor a patient’s request to have a chaperone” and that clear expectations should be established to ensure the chaperone upholds professional standards and confidentiality.
It’s a practice also endorsed in the ACP Ethics Manual, and one followed by Ende.
“In my practice and in my hospital, it is standard for male doctors to have a chaperone in the room for things like pelvic exams,” he said. “In general, the more intimate the examination, the more the physician is encouraged to offer the presence of a chaperone. The manual also notes, though, that some patients view the presence of another person in the examination room as an intrusion into their privacy.”
A 2010 story in The New York Times noted that the use of chaperones isn’t always possible in a busy clinical setting. Some have criticized the use of the term “chaperone,” as it may imply a physician can’t be trusted and needs to be supervised.
Caplan says a patient should be able to request a third party be in the room if they wish, but having chaperones as routine practice may be too much.
“Routine chaperoning is overkill. While there are instances of misbehavior and even sexual abuse, it is better dealt with by swift punishment,” he said.
Patients taking action
Ende says patients should feel comfortable taking action to ensure their privacy and dignity is respected.
“Patients should not hesitate to request steps to safeguard their privacy or to report suspected violations to the appropriate authorities, which could include the institution, the state medical board, and medical professional societies,” he said.
As for physicians, Ende says they also shouldn’t hesitate to report any inappropriate behavior.
“Hospitals have training in this and when to report colleagues, including superiors, if violations or problems in professionalism are noted,” he said.
In his statement, the AMA president said all physicians have a responsibility to eradicate unethical behavior.
“Respecting patients and protecting their dignity and privacy are paramount obligations of the medical profession,” Barbe said. “Stamping out instances of unethical behavior within the medical profession is a vital job of all physician practices and medical staffs, as well as the state medical boards.”