Medical students' perceptions of patient-initiated sexual behavior

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.