Inappropriate patient sexual behaviors.

Ever since this nation was riveted and divided by the Clarence Thomas confirmation hearings, the subject of sexual harassment seems ubiquitous. Partisans of that confirmation process still battle in the media, too often focusing on the specifics of the accusations and directing our attention away from the critical issue. Missed within the acrimonious debate is an understanding of the nature of the accusation. Sexual harassment and inappropriate sexual behaviors may most often have women as their immediate victims, and to that extent women should rightly be indignant. But in reality, sexual harassment and inappropriate sexual behaviors are not simply against women, but against the fabric of society and the dignity of us all.

This topic is brought home in alarming proportions by the study of McComas and colleagues in this issue. Their data suggest that almost all of us will be exposed to inappropriate sexual behaviors from our patients - and that includes men as well as women. The recorded behaviors varied in their intensity, from jokes to innuendo to rape. The implications are frightening. We live in a world where the beauty of human sexual interaction has all too often given way to a tragic reality in which there are victims and victimizers, in which some see women (or men) as objects rather than as people, and in which the tolerance of inappropriate behaviors is commonplace.

The data of McComas and colleagues suggest that during our student days we may even be socialized into accepting this behavior. We may first experience this abuse as students, and, apparently, either because of our inclinations or our environments, we do very little about it. Many fear that the ubiquity of violence in our media desensitizes us to brutality, but what is the effect on us of the inappropriate sexual behaviors that infest our daily lives? Perhaps shock gives way to coping in a perversion of the right of passage into professionalism. Commenting on the article, Bruckner asserts that inappropriate sexual behavior on the part of patients is not a women's issue alone. She suggests it is a professional issue, and, in view of the nature of our profession, few could argue with that proposition. But it must be more than that - it must be a societal issue.

The dignity of our patients is violated when we allow them the freedom to be abusive and sexually inappropriate. To hold patients accountable for their actions is to show respect for them as human beings. Allowance of the inexcusable in the absence of an identified pathological basis is neither humane nor in the patient's best interests. Silence has ill served us all. The time has come for us to consider how we deal with this subject in our clinical environments. The time has also come for us to look at our own behaviors. Do we tolerate, abet, or condone insensitivity and/or cruel interaction? I am not suggesting that the victims are responsible for their own abuse, but I firmly believe that each of us as members of a profession and society must consider how we have allowed these behaviors to become so common.