Sexual misconduct in our society: Can we do better?

Collectively our society can do better. Women should not have to rely on voluntary social networks, valuable though they are, to have the confidence to come forward when they encounter unacceptable sexualised conduct.

Does your organisation have a sexual misconduct policy? More importantly, does it have a process that is truly supportive of victims so that they can come forward with confidence and thereby protect not only themselves but the reputation of your organisation?

In 1982, as the newest and youngest member of the Medical Board of Victoria, I was part of the Board’s tribunal that heard allegations of sexual misconduct against an orthopaedic surgeon made by six women who had consulted the surgeon because of persistent pain in the coccyx. The surgeon denied the allegations but the five member tribunal unanimously believed the evidence of the women who did not know one and other. The surgeon was found guilty and was deregistered. He went home, wrote a note to his family admitting his guilt, and then committed suicide. What I recall most strongly from this hearing was the shame that the women victims clearly felt, even when no blame could possibly be attributed to them, and the deep distress the women experienced in giving their evidence and being cross-examined by a male barrister.

Unsurprisingly, the subject of sexual misconduct by doctors has remained of intense interest to me. There are lessons that medical regulators have learned, some more slowly than others, from handling these matters. Much of what has been learned is relevant to how other organisations and institutions should approach prevention of sexual misconduct and encouragement of complainants to come forward. That institutions have a long way to go in this regard is exemplified in the most recent Australian case to receive publicity. So what can be learned about sexual misconduct from observing it among members of the medical profession? Little of what follows is new information. Many excellent books dating back thirty or more years have been written on this topic, for example this book by American psychiatrist, Dr Peter Rutter.

Who are the perpetrators? Nearly all instances involve a male as the perpetrator. A small proportion, estimated at around 4%, involve female perpetrators or homosexual relationships. The victims are universally in a situation of having less power that the perpetrator. As Rutter wrote in 1989, this is ‘because men so often control access to a woman’s future – and to her physical, psychological, spiritual, economic or intellectual well-being’ and added ‘the mere presence of sexual innuendo from a man who has power over her can become a barrier to her development’.

For doctor perpetrators, this power imbalance is often combined with varying degrees of vulnerability in the victims. Vulnerability is almost always the case when a male psychiatrist seduces a female patient. Such conduct is especially egregious when the victim’s vulnerability is tied to past sexual abuse and to the very reasons she has sought his professional help.

In the case of sexual misconduct by doctors, the long-term outcome is almost always serious emotional and psychological harm to the victims. Many refuse to ever attend a male doctor again. Another not infrequent consequence of being the victim of sexual misconduct is self-blame.

Why do men behave this way? Many theories have been offered. In the view of Rutter, based on hundreds of interviews, most men lead rich fantasy lives including sexual fantasies and in certain situations some men make the grievous error of seeking to turn those sexual fantasies into a reality. They too are harmed by their conduct but this pales into insignificance when compared with the harm done to their victims. Rutter also believes that the universality of the sexual fantasies of men is a barrier, possibly subconscious, to men in leadership positions taking appropriate actions to deal with male colleagues who offend.

Can sexual misconduct be prevented or deterred? In Australia, since 2010, doctors have been obliged by law to report allegations of sexual misconduct to the medical regulator. Where the allegation is raised within the confines of a confidential patient-doctor consultation, this can be problematic as the woman may not be prepared to face the stress involved in having her allegation investigated and adjudicated. The strength to face this stress may come if the woman learns that she is not the only victim. Although it was a desirable legislative step, there is no evidence to date that mandatory reporting has reduced the incidence of sexual misconduct as it remains the commonest reason for deregistration of doctors.

Another form of deterrence is through encouraging victims to come forward; i.e. the earlier such conduct is identified, the fewer later victims there might be. This can only be achieved by making the complaints process as welcoming and supportive as possible and leaving the decision to proceed to prosecution entirely in the hands of a well-supported victim. Thus each complaint must be handled by a trained investigator of the same gender as the victim. The number of times that the complainant is interviewed should be kept to a minimum. As the process can be slow, often for legitimate reasons, the primary investigator should regularly keep the complainant informed of progress.

In addition, in organisations that handle these matters frequently, consideration should be given to funding an independent support service. Such independent services have proven successful as they can provide continual emotional support during the investigation, during any tribunal or court hearing and in the aftermath. In their absence, investigative staff might undesirably be drawn in to provide such support or, equally undesirably, might be seen to be remote and unhelpful. Investment in a support service sends a clear message that complaints are welcome and that sexual misconduct will not be tolerated: thus a support service is part of early detection and prevention. To avoid any suggestion of bias, the support service should also be offered to the person accused of misconduct.

Actions taken after adjudication, in terms of what is most often called punishment, will vary according to the circumstances but whatever is decided upon must send a clear message of zero tolerance. For those perpetrators who are thought to be redeemable, actions may include insistence on their obtaining professional help before they can be reintegrated into the workplace. The actions decided upon are part of prevention as they can send a clear message as to what type of conduct is unacceptable. Within organisations, whether they be universities, businesses, medical colleges or other, strong leadership backed by clear policies and education programs is also essential.

Collectively our society can do better. Women should not have to rely on voluntary social networks, valuable though they are, to have the confidence to come forward when they encounter unacceptable conduct. Does your organisation have a sexual misconduct policy? More importantly, does it have a process that is truly supportive of victims so that they can come forward with confidence and thereby protect not only themselves but the reputation of your organisation?

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Kerry Breen AM is a retired physician and gastroenterologist and past President of the Medical Practitioners Board of Victoria. He is a co-author of Good Medical Practice: Professionalism, Ethics and Law, published in 2016 (4th ed).

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