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When a white coat fear is really a white coat fear: implications of sexual abuse by a physician for interactions with healthcare professionals

Kim Dunleavy, A Kubo Slowik, C Daitch, L Elconin, M Horowitz, W Kestenberg, J Sobol, N Wicks, N Withheld

Abstract


Background and Purpose: Sexual exploitation of patients by medical practitioners has devastating effects on victims, including difficulty seeking and tolerating healthcare. This case report describes the long-term effect of a rape by a physician on interactions with healthcare providers. The implications for healthcare encounters are presented from the patient’s perspective as well as from those of multiple healthcare providers.

Methods: The case report used a qualitative descriptive approach with healthcare providers from multiple specialties contributing semi-structured ethnographic interviews and a first person case history and commentary provided by the patient. A modified Delphi approach was employed to determine consensus on the key mechanisms for improving patient tolerance of medical management.

Outcomes: Key elements which helped the patient tolerate medical care included allowing family or an assistant in the room, observing the patient for signs of discomfort, adjusting techniques, avoiding touch, not wearing a white coat and carefully selecting specialists for referral. Interdisciplinary communication played a significant role in limiting major fear responses during breast cancer surgery. Patient-centered approaches such as receptive communication, respect for the patient’s feelings, detailed explanations and giving the patient control were considered vital across multiple professional disciplines.

Discussion: All healthcare providers modified their approaches to provide a person-centered approach to care. In the presence of a history of abuse, communication becomes complex and challenging. Psychotherapeutic support is essential and developing a referral base of patient-centered practitioners is likely to enhance the patient’s experiences. Presence or absence of patient-centered management could facilitate or setback interactions with other healthcare providers for patients with a history of physician abuse.

Keywords


PTSD, patient-centered care, person-centered medicine, physician sexual abuse, shared decision-making, white coat hypertension

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References


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DOI: http://dx.doi.org/10.5750/ejpch.v2i3.727

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