LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement. Seules peuvent etre retenues pour publication les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession des droits d'auteur. Les lettres ne doivent rien contenir qui ait ete pre0sente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Where is the evidence? In "Ontario's task force on sexual abuse: McPhedran fights
back" (Can Med Assoc J 1992; 146: 555-556, 558) Charlotte Gray states that there is "solid statistical evidence that between 7% and 13% of physicians have had sexual contact with patients." I assume that these figures refer to Ontario but are felt to have implications for the rest of Canada. I would appreciate the references for this evidence.
on Sexual Abuse of Patients for the Ontario College of Physicians and Surgeons during 1991 I am responding to Dr. Vincent's interest in the evidence of sexual contact. The degree to which patients experience sexual abuse by their physicians was until recently never considered important enough to be investigated. Therefore "hard" data are limited; moreover, such evidence only partly defines the extent of the problem. In only 6 months during 1991 our task force heard from hundreds of patients by telephone and letter; 61 women and men reported to the task force in person. Overall, we documented 303 reports of sexual abuse by those in positions of trust, most of them physicians. Compared with other jurisdictions in North America (e.g., Minnesota, California, Massachusetts and Alberta) the Ontario sample appears to be the largest obtained so far. The Final Report of the Task Force on Sexual Abuse of Patients' cites four US studies that made use of anonymous selfreporting questionnaires to investigate sexual abuse. Kardener, Fuller and Mensch2 found that 5% to 13% of respondents (psychia-
trists, obstetrician-gynecologists, surgeons, internists and general practitioners) had engaged in erotic contact (defined as behaviour
intended to arouse or satisfy sexual desire) or sexual intercourse with patients, and 5% to 7.2% Merville 0. Vincent, MD, CM, FRCPC acknowledged that intercourse Salmon Arm, BC had taken place. The other three studies3-5 sur[The chairperson of the task force veyed psychiatrists only and reresponds.] ported incidence rates of sexual Having chaired the Task Force contact with patients or former JULY 15,1992
patients of 7.9%, 7.1% and 7.8% respectively. After the task force's preliminary report generated such concern about "hard" data the Canada Health Monitor and Price Waterhouse Management Consultants released in October 1991 the results of Canada's first telephone survey of women patients' experience of sexual abuse by their physicians (Globe and Mail, Toronto, Oct. 28, 1991: A1-A2): 549 Ontario women over the age of 15 years were polled, and about 8% said that they had been sexually harassed or abused by their physicians. Early this year the Ontario Medical Association commissioned a survey of Ontario physicians' awareness of the sexual abuse of patients. It was not the intent of the survey to measure the incidence of abuse - the exact numbers are impossible to determine. However, it is interesting that when asked "Has there ever been a time when you would have been required to report a colleague if this regulation [to report to the College of Physicians and Surgeons of Ontario if there is reason to believe that a colleague is sexually abusing a patient] had been in place?" 9% of respondents said "Yes."6 When medical students and residents were excluded the figure was 11%. Among physicians with more than 10 years in practice it was 13%. The incidence of sexual abuse of patients is difficult to measure, and the results of surveys are affected by many factors (e.g., the sex of the interviewer). The exact figure is not as important as the first-hand evidence received by the task force that such abuse takes place. The debate has now CAN MED ASSOC J 1992; 147 (2)
147
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement. Seules peuvent etre retenues pour publication les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession des droits d'auteur. Les lettres ne doivent rien contenir qui ait ete pre0sente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Where is the evidence? In "Ontario's task force on sexual abuse: McPhedran fights
back" (Can Med Assoc J 1992; 146: 555-556, 558) Charlotte Gray states that there is "solid statistical evidence that between 7% and 13% of physicians have had sexual contact with patients." I assume that these figures refer to Ontario but are felt to have implications for the rest of Canada. I would appreciate the references for this evidence.
on Sexual Abuse of Patients for the Ontario College of Physicians and Surgeons during 1991 I am responding to Dr. Vincent's interest in the evidence of sexual contact. The degree to which patients experience sexual abuse by their physicians was until recently never considered important enough to be investigated. Therefore "hard" data are limited; moreover, such evidence only partly defines the extent of the problem. In only 6 months during 1991 our task force heard from hundreds of patients by telephone and letter; 61 women and men reported to the task force in person. Overall, we documented 303 reports of sexual abuse by those in positions of trust, most of them physicians. Compared with other jurisdictions in North America (e.g., Minnesota, California, Massachusetts and Alberta) the Ontario sample appears to be the largest obtained so far. The Final Report of the Task Force on Sexual Abuse of Patients' cites four US studies that made use of anonymous selfreporting questionnaires to investigate sexual abuse. Kardener, Fuller and Mensch2 found that 5% to 13% of respondents (psychia-
trists, obstetrician-gynecologists, surgeons, internists and general practitioners) had engaged in erotic contact (defined as behaviour
intended to arouse or satisfy sexual desire) or sexual intercourse with patients, and 5% to 7.2% Merville 0. Vincent, MD, CM, FRCPC acknowledged that intercourse Salmon Arm, BC had taken place. The other three studies3-5 sur[The chairperson of the task force veyed psychiatrists only and reresponds.] ported incidence rates of sexual Having chaired the Task Force contact with patients or former JULY 15,1992
patients of 7.9%, 7.1% and 7.8% respectively. After the task force's preliminary report generated such concern about "hard" data the Canada Health Monitor and Price Waterhouse Management Consultants released in October 1991 the results of Canada's first telephone survey of women patients' experience of sexual abuse by their physicians (Globe and Mail, Toronto, Oct. 28, 1991: A1-A2): 549 Ontario women over the age of 15 years were polled, and about 8% said that they had been sexually harassed or abused by their physicians. Early this year the Ontario Medical Association commissioned a survey of Ontario physicians' awareness of the sexual abuse of patients. It was not the intent of the survey to measure the incidence of abuse - the exact numbers are impossible to determine. However, it is interesting that when asked "Has there ever been a time when you would have been required to report a colleague if this regulation [to report to the College of Physicians and Surgeons of Ontario if there is reason to believe that a colleague is sexually abusing a patient] had been in place?" 9% of respondents said "Yes."6 When medical students and residents were excluded the figure was 11%. Among physicians with more than 10 years in practice it was 13%. The incidence of sexual abuse of patients is difficult to measure, and the results of surveys are affected by many factors (e.g., the sex of the interviewer). The exact figure is not as important as the first-hand evidence received by the task force that such abuse takes place. The debate has now CAN MED ASSOC J 1992; 147 (2)
147
