"My pain is in my butt. Right there.” He points and then pokes me in the left butt cheek. I jump back and tell him to stop. He looks at me, shocked that I find his behavior inappropriate.

Over the years, both men and women feel the need to touch me in order to "help" me understand their symptoms better. They touch my back or my neck to demonstrate where they are feeling pain. It makes me uncomfortable every single time. Every. Single. Time. Sometimes I spoke up. Sometimes I didn't. Some apologized. Some did not. One patient even asked me why they were not allowed to touch me if I was allowed to touch them. Now, I was forced to explain that I was trained in examining patients. "I'm not just touching you, I'm examining you. There's a difference." Sigh.

I ask a male colleague if this has happened to him. He looks at me a bit perplexed and answers no.

Fortunately, my experience was with a small subset of patients. The majority of patients were and continued to be respectful. I realized that most were not aware that they had crossed a line personal to me. This was difficult for me to manage. How do you respectfully tell someone that your personal space has been invaded, without fear of confrontation or a bad online review?

The conversation with my male colleague made me realize that the male and female experience working in medicine is different. Not only with income and career advancement opportunities. In general, men are more respected, better paid, and promoted more often than women. Quite frankly, I was kind of surprised to hear that patients were treating me differently because I am a woman. This might have been a bit naive on my part but eye-opening nonetheless.

But then something changed in the world around us. More and more people started to speak up and #MeToo was born. Social media blew up with countless stories of inappropriate encounters. Some more egregious than others. But it made people think more and be more conscious about how they treat others. Even I was more aware. Over the past few years, not one patient has touched me when describing their pain. In fact, I actually remember the last time it happened. The male patient touched my upper back and then immediately withdrew his hand and started to apologize profusely. I accepted his apology, but I was also intrigued by his immediate apologetic reaction. That's when I realized the change in the world was not only for people who had been sexually assaulted but also for medical professionals like me who were being treated differently just for being women.

A 1993 survey of female physicians in Ontario, Canada, found 75% reported being sexually harassed by patients. 1993! A time when these types of conversations were taboo. In this survey, it is interesting to note that sexual harassment ranged anywhere from inappropriate comments/stares and touch, to rape.

Another article in AAMC included helpful strategies when dealing with harassment from patients, citing a technique called ERASE:

• Expect harassment might happen. 
• Recognize how the patient encounter went. Was it innocent or not? 
• Address the issue by preparing yourself ahead of time. Rehearse what you should say. 
• Support your colleagues who had negative experiences. 
• Establish/encourage your colleagues and employees by establishing policies or training programs.

These strategies are important. I find it interesting that it is important to recognize that harassment might happen, so one must be prepared beforehand. It is also important to first ask yourself how the patient encounter went. Was it really innocent or not? This is where I have to pause and think. When I look back at the uncomfortable patient encounters I experienced, I would like to believe that most patients were being innocent. They were concerned about explaining their symptoms to me and trying to make sure I understood their pain. Maybe touching my back or neck reassured them that I understood their symptoms. Maybe I am naive and grew up in a bubble. Maybe these are just excuses. Regardless, I still felt uncomfortable, and many times I didn’t know how to appropriately address the issue. I didn’t rehearse what to say ahead of time. Most of the time, I did not look for support. Maybe I was and possibly continue to be scarred from the first time I looked for support. When I spoke to a supervisor about the patient that touched my butt, the response was, “Really? He did that? Are you sure?” punctuated with a blank stare. What was the main concern? We should not lose the patient so let’s not make any accusations. Maybe I had misinterpreted the encounter.

The lack of support and workplace policies made this situation difficult for me. It also probably contributed to my supervisor’s response. Providing support and establishing policies would make the workplace a safer environment for the medical team. These policies should protect a health care worker who reports an uncomfortable encounter with a patient. Judgment should be strongly discouraged. Providing mental health support should be offered. The policies should also include steps for administrators to follow when deciding what to do with a patient who has behaved inappropriately. Should their care be transferred to another clinician within the practice? If so, should the other clinicians be made aware of the problem? Or should the patient be discharged? 

This is a difficult situation to handle in health care. We are trained to care for our patients. We are not well prepared to deal with uncomfortable situations. Following the strategies above would certainly be beneficial for any health care organization. I am happy to learn about these strategies now, even if these encounters were years ago. I am better prepared and thankful that the majority of my patients are considerate of me.

Have you had an uncomfortable experience with a patient? Share in the comments.

Karine Ngoie is an interventional pain management physician assistant in Lawrence, Massachusetts. Remembering to be true to herself, respectful of others, and honest keeps her grounded personally and professionally. Karine is a 2022–2023 Doximity Op-Med Fellow. Connect with her on LinkedIn.

Illustration by April Brust