Healthcare is unique because it involves intimate interactions that may seem like routine exams, but they’re not.

In the healthcare system, sexual boundary violations are a serious problem. Studies have found that professional sexual misconduct against patients may be common. However, valid prevalence numbers are unavailable. A similar, unrelated statistic is also missing: physician suicide.

About half of the material reviewed indicated healthcare sexual encounters with people over 18 were against their will. Of the forty women in one survey, 3.2% reported unnecessary physical exams, while eight men (0.6%) also experienced this. Additionally, thirty-one women (2.5%) and seven men (0.6%) stated healthcare workers sexually harassed them. A young boy shared that he had a bad experience with his family doctor, accusing him of sexual assault and solicitation, but his claims were not believed. The physician was highly respected in the community, so the boy must have lied, right?

A terrible case of abuse happened with Dr. Larry Nassar, a sports medicine doctor who was in charge of the USA gymnastics team and other organizations. People who had been abused by Nassar told others about it, but USA Gymnastics and other organizations did nothing to stop it, letting it happen for years.

Nassar was the team doctor for 18 years and used his job to attack and abuse hundreds of young athletes sexually. He was charged with sexually abusing 265 women and girls while pretending to treat them medically. After admitting to having child pornography, he was sentenced to 60 years in prison. For admitting seven counts of sexual assault, he got 40 to 175 years in prison.

The US government was fined over $138 million for the FBI's failure to investigate the charges against Nassar. Why did they not investigate, and why did the school not act on any complaints?

How common is sexual assault by those who work in healthcare? That seems to be a big black hole in our research unless some cases come to light. A coworker who had previously worked at a mental health clinic brought up one of those cases for me.

The clinic, he said, served primarily immigrant families with special psychiatric help for their children. One day, a woman came in with her child for an appointment with the psychiatrist. Once in the room, he instructed the woman to strip to the waist, and he fondled her breasts repeatedly. After he had finished, he told her to put her blouse back on, and he dismissed her with an appointment for the following month.

The woman asked the receptionist, in her native language, if other mothers had the same experience at the psychiatrist's office. The receptionist reassured her but called a psychologist and informed him of what had happened.

The psychologist and his colleagues confronted the psychiatrist. Clinic management, rather than seeking criminal charges against him, told him to go on vacation, resign from the center, and leave the state. He did just that and got his medical license in a neighboring state, where, for all we know, he may be continuing this same behavior. Not all states do significant background checks on anyone seeking a medical license. Consider the case of Dr. Swango.

How did management respond when the professionals confronted the clinic director about this sexual assault? The director said, "He's a physician and has a right to a medical exam whenever he wants." Do I need to say more?

I heard of a young man whose mother, a psychologist, referred him to a female psychologist for therapy. The female psychologist promptly seduced him, had sex with him at each appointment, and charged him for therapy. I don't know if the young man ever told his mother or the outcome of this instance of incredible ethical boundary violations.

How many more instances of sexual assault do publications never pick up? For example, a physician affiliated with a major medical center in New York City has been charged with 50 counts of drugging and sexually assaulting female patients. Not only did he assault the women, he videotaped the assaults and kept them in his home. This is only one case of thousands.

In an Australian study confined to the period 2011-2016 of 15 health practitioner categories, there were 1507 reports of sexual misconduct against 1167 of the 724,649 registered health practitioners (0.2%). Of these, 208 (18%) were the subject of more than one report between 2011 and 2016. Of these, 381 (25%) were about alleged sexual relationships, and 1126 (75%) were about sexual harassment or assault.

How did the offenders break down into their career categories? Psychiatrists (15.2 notifications per 10,000 practitioner-years), psychologists (5.0 notifications per 10,000 practitioner-years), and general practitioners (6.4 notifications per 10,000 practitioner-years) were more likely to receive sexual relationship notifications. The rate was higher for regional/rural practitioners than for metropolitan practitioners.

The researchers noted that they "only captured events reported to regulators, and therefore do not include all instances of sexual misconduct.” We are left to wonder how many unreported cases there were in reality.

And surgery appears to be a place for sexual assault of patients and co-workers, too. Sexual misconduct in surgery in the UK was looked into so that actions can be taken that are better targeted to make healthcare safer for both staff and patients.

People who had been sexually harassed, attacked, or raped by coworkers were asked to fill out a survey. They were also asked if they had seen this happen to other people at work. Compared to men, women were much more likely to have been sexually abused or to have seen it happen to other people.

As an illustration, most women (63.3%) and some men (23.7%) have experienced sexual harassment at work. As for being sexually assaulted by coworkers, 29.9% of women and 6.9% of men said they had been sexually attacked. The conclusion of these researchers was that many respondents had been sexually harassed, which is a major problem in the field. According to them, people in the UK do not trust the groups that are supposed to be handling this problem.

What is the status of trust worldwide regarding healthcare professionals? It is an area that is not easily discussed or researched, and both patients and staff members are subjected to this behavior.