Sex and gender and the impaired therapist

Surgeons in Difficulty: An Exploration of Differences in Assistance-Seeking Behaviors between Male and Female Surgeons

BACKGROUND

Physician burnout is associated with diminished ability to practice with requisite skill and safety. Physicians are often reluctant to seek help for an impaired colleague or for impairment that affects their own ability to practice. To better support surgeons in difficulty, we explored sex differences in assistance-seeking behaviors under stress.

STUDY DESIGN

Surgeons in 3 national societies completed an IRB-approved anonymous multiple-choice and free-text response survey. Responses were explored with the general linear model using item-specific continuous and categorical methods.

STUDY DESIGN

Two hundred and twelve surgeons (n = 79 [37.3%] male, n = 133 [63%] female) responded. Although men and women worked similar hours (p > 0.05), women worked more clinical (p < 0.01) and fewer administrative hours (p < 0.01) in later age (F = 7.88; degrees of freedom [df] 4/145; p < 0.01). Women were less satisfied with work-life balance, as identified by aggregate variables related to emotional/decisional partnership, non-work-related chore support, and personal fulfillment (F = 15.29; df 3/16; p < 0.01), but change jobs less frequently (F = 4.23; df 1/201; p < 0.05). Males are more likely to seek help from colleagues (chi-square 107.5; p < 0.01) or friends (chi-square 123.8; p < 0.01) and women are more likely to seek support from professional counselors (chi-square 146.8; p < 0.01). Almost one-third of surgeons would ignore behaviors that adversely impact well being and could result in potential personal or patient safety.

CONCLUSIONS

The differences between the assistance-seeking and reporting behaviors of male and female surgeons in distress could have implications for identification and treatment of this population. These findings can be used to develop educational activities to teach surgeons how to effectively handle these challenging situations.

The status of ethics education in Australasian psychiatry

OBJECTIVE

To determine to what extent ethics is taught and how it is taught to psychiatrists-in-training across Australasia.

METHOD

Anonymous mail-out survey of training directors.

RESULTS

The questionnaire was completed by 23 of 25 training directors (response rate = 92%) who reported on 625 trainee psychiatrists. Individual one-to-one case supervision was adopted by 96% of the programs for teaching ethics; formal teaching in seminars or lectures was chosen as the second most common method in 70% of programs. Topics most commonly taught in formal seminars were so taught in only 70% of programs or less.

CONCLUSION

A uniform curriculum in psychiatric ethics is needed. The results are discussed in relation to identified needs for improvement.

Sexual abuse in therapy: gender issues

OBJECTIVE

That sexual abuse in therapy occurs predominantly with male perpetrators and female patients is a phenomenon that requires analysis in terms of gender relations. Such an analysis is undertaken here from the perspective of feminist psychoanalytic and psychosocial theories.

METHOD

Data informing the analysis are derived from assessments of 40 women who experienced sexual abuse in therapy. These women had mostly presented depression, 68% had a history of childhood abuse, and one half were themselves helping professionals.

RESULTS

The majority were seriously damaged by the abusive therapy. Offenders were chiefly male (90%) and most were senior, well-qualified therapists of high status: some were charismatic leaders or teachers. Such a group cannot be dismissed as marginal, deviant, or ill-informed; a more systemic analysis is necessary to understand how the professions spawn and sometimes protect offenders.

CONCLUSION

It is concluded that the professional culture mirrors fundamental problems of gender relations that inhere in the larger socio-cultural context where they are expressed in various forms of sexual abuse and violence. A cultural change requires better education on issues of power and sexual politics.

Origins and development of the injunction prohibiting sexual relationships with patients

This paper addresses the historical context, both ancient and modern, of the injunction prohibiting sexual relationships with patients. Reference is made to the increasing knowledge of factors predisposing to such breaches of ethical conduct and to the common dangers and consequences of sexual relationships with patients. Such research findings demonstrate adequate cause for the application of the injunction in all of the health care professions. The modern social context of liberal humanism and feminism, along with the recognised analogy with child sexual abuse, are considered as influences in the current resurgence of interest in the injunction itself.

Professional misconduct in psychiatry: sexual behaviour with patients. A report of recent New South Wales findings

In the period 1989-1991 the Medical Tribunal in the state of New South Wales conducted enquiries into seven complaints about professional misconduct of a sexual nature incidental to psychiatric treatment. This study is submitted in the interests of patients, profession and public in accordance with the ethos of the Medical Practitioners Act (NSW). It is based on personal observations and published legal documents and refers to the legal context and procedures. It addresses the substance and style of complaints and complainants and of defences and respondents. The names of six psychiatrists and one trainee psychiatrist were removed from the Medical Register. In three instances decisions or orders were unsuccessfully appealed in the Supreme Court. In two instances associated complaints (of illicitly prescribing drugs of addiction and of divulging confidential information) were also found to be professional misconduct. Courtroom pitfalls are illustrated and practical principles explicit in judgements are reiterated.