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Question

Difficulty: MediumPatient-Physician Relationship and Boundaries

A 32-year-old man comes to the primary care clinic for a routine follow-up of well-controlled essential hypertension. During the visit, he makes several overtly sexually suggestive remarks toward the physician and comments inappropriately on her physical appearance. The physician feels uncomfortable but notes that the patient is medically stable and in no acute distress. Which of the following are appropriate professional actions for the physician to take regarding this patient? (Select all that apply)

  1. Directly inform the patient that the comments are inappropriate and establish clear professional boundaries.Answer
  2. Require a clinical chaperone to be present during all future medical encounters with this patient.Answer
  3. C
    Immediately terminate the patient-physician relationship and refuse any further medical care.
  4. D
    Reassign the patient to another physician in the practice without documenting the behavioral incidents.
  5. E
    Order an urgent psychiatric consultation to assess the patient's clinical decision-making capacity.

Answer

The correct professional actions are to directly inform the patient that the comments are inappropriate and to require a clinical chaperone for all future medical encounters.
When a patient makes sexually suggestive remarks without posing an immediate physical threat, the physician's first responsibility is to re-establish the professional framework. This is achieved by directly and unequivocally informing the patient that the behavior is inappropriate. Additionally, to ensure a safe clinical environment and mitigate liability, the physician should require a clinical chaperone for any future interactions. These steps allow for the continuation of necessary medical care while strictly enforcing ethical boundaries.

Step-by-Step Solution

1
Identify the primary ethical and professional issue.
The patient is committing a boundary violation through sexually suggestive remarks, but is not posing an immediate physical threat.
Accurate identification of the situation determines whether immediate discharge, law enforcement involvement, or professional boundary setting is required.
2
Determine the appropriate immediate verbal response.
The physician must directly confront the behavior, stating clearly that the remarks are inappropriate.
Direct communication establishes boundaries and gives the patient an opportunity to correct their behavior before extreme measures like termination are taken.
3
Identify necessary protocol adjustments for future care.
A chaperone should be mandated for all subsequent visits.
Chaperones protect the physician from further harassment and safeguard the practice against potential misunderstandings or false claims.

Key Concept

Patient-Physician Boundaries and Management of Inappropriate Sexual Behavior
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Topics

Patient-Physician Relationship and Boundaries

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