Abuse by docs leaves patients scarred

Victims sexually exploited by doctors suffer psychological distress, loss of trust and trauma

Reports of sexual assault are so commonplace now that it takes a specially disturbing crime to lull us out of our apathy. However, a recent case has shocked the global community, especially the medical fraternity.

Indian-origin doctor Manish Natverlal Shah was given three life sentences for 90 sexual assaults on female patients while working in London, when he carried out invasive examinations for sexual gratification. He was a general practitioner and played on the victims’ fear to recommend regular breast and vaginal examinations when there was no clinical need.

The consequences are many — when the sacred boundaries of a doctor-patient are transgressed, the psychological impact on the victim is severe.

“Anyone can be a perpetrator. A doctor, therefore, is no exception. Unfortunately, in this case, a doctor has misused his power and position to sexually assault vulnerable women that consulted him,” says Dr Veena Satyanarayana, associate professor in clinical psychology and consultant-trauma recovery clinic, NIMHANS.

She adds, “All types of sexual abuse can potentially have an adverse psychological impact on survivors. It can range from sub-clinical distress to common mental disorders such as anxiety and depression, to more severe presentations in the form of post-traumatic stress disorder and complex trauma.”

NIMHANS has set up a trauma recovery clinic in the NIMHANS Centre for Well-Being at BTM Layout to help survivors overcome psychological consequences of trauma and violence.

Breach of trust leaves patients confused

Patients put themselves in a vulnerable position with doctors and when this trust is broken, it leaves them confused and hurt — traumatic feelings that might take years to heal.

“Sexual abuse is in itself a very traumatic event and when it comes from a doctor, it is even more shocking. You reach out to a doctor when you are unwell and/or distressed, so you are already going through a trying time. You might be telling them things and details you might not have told anyone else. So you trust them and when that person abuses you, it leaves a mental scar,” says Neha Cadabam, consultant psychologist, Cadabams Hospitals.

She points out that it leads to patients having trust issues and being extremely fearful about reaching out to a doctor again. Victims might start avoiding doctors altogether or go to only female doctors. Others have trouble opening up to therapists or getting into a relationship, since they feel no one is trustworthy.

“Even when they fall sick, they will not go back to a doctor and might instead resort to self-medication or compromise on the quality of healthcare they get,” says Neha.

Communication is key

Since people in medical positions command immense respect, sometimes the victims blame themselves for what happened or wonder if they are overreacting.

“A doctor is supposed to openly communicate with the patient before he/she starts an invasive test -- ‘I am going to be doing so and so because I need to understand this.’ It’s like consent in a sexual relationship; checking of any of your private parts needs your consent too,” points out Neha.

She adds that even if the doctor does not have malicious intent, the patient may feel uncomfortable or compromised because they weren’t communicated with properly as the doctors did not feel it was important.

Not a new phenomenon

In an article titled ‘Is there an elephant in the room? Boundary violations in the doctor-patient relationship in India’, which appeared in the Indian Journal of Medical Ethics in 2016, authors Sunita Simon Kurpad, Tanya Machado and R B Galgali conducted an anonymous postal survey on the awareness of the occurrence of non-sexual and sexual boundary violations in the doctor-patient relationship in India. It was conducted with psychiatrists and psychologists working in Karnataka. 46 per cent of the respondents reported having heard of cases of inappropriate/ unnecessary physical examination, 60 per cent had heard of inappropriate touching, 42 per cent were aware of sexual talk/ jokes with the patient, 50 per cent were aware of/heard of medical practitioners sexually touching the patient.

Keep your children safe

Deepa Kumar, entrepreneur and crusader for child safety at How To Tell Your Child (HTTYC) says, “The way to prevent abuse of children is by having multiple and ongoing conversations with them on the subject. HTTYC methodology covers all forms of sexual abuse other than only touch so it’s more comprehensive.”

She points out that a simple strategy is to have the parent and the doctor discuss what the physical examination would entail, in the presence of the child.

“This would ensure that the doctor does not attempt any predatory act as the parents know exactly what the examination would entail. This would also allow the child to identify that what the doctor was attempting was inappropriate,” she says.

She adds that if the child is very young, the parent should be with the child during examination of any kind

It’s the confusion, lack of vocabulary and shame that enable such incidents. “All these can be combated with positive conversations and strategies,” Deepa says.