THESE PEOPLE ARE THE BOTTOM of the barrel,” Ann Landers said. “No punishment is bad enough.”No, Ann Landers was not talking about carjackers who throw babies from windows. She was referring to doctors who have sex with their patients.
The subject of sex with patients is not a hot topic in doctors’ lounges around most towns. It excites non-doctors far more.
But examining the line drawn between doctors and patients in personal, emotional and sexual terms is illuminating.
The doctor is granted a special exception in our culture. No husband would be pleased to learn his wife had stripped naked before another man and had her private parts handled.
Unless, of course, that other man was her gynecologist.
My neighbors know I have examined the breasts of their spouses, yet they are unperturbed about it.
This exception is granted on the condition that I look at these women “clinically” and never display any overt sexual behavior toward them.
That prohibition extends beyond the time and place of the examination. When I see the patient at the swimming pool I am expected to be as sexually uninterested as I was in the examining room.
All this is understandable and practical. I could not function as a physician, nor they as my patients, if it were any different. It is the tacit contract I have with the patient.
When non-medical friends have had a second gin-and-tonic, they sometimes ask how I can do it.
“How can you look at a beautiful woman, lying naked on the examination table, and not get turned on?”
After all, that’s what Playboy is all about. The visual turn-on. Looking at nude women. But as skin-magazine editors well know, titillation doesn’t just happen. The women in their magazines lose allure unless they are posed in the proper setting.
A woman in a bikini at a pool draws a few stares, but she would have a much greater impact if she greeted you at your door with wineglass in hand.
The fact is, as a doctor, you don’t get turned on just because someone is naked. There is an old medical adage: 90 percent of sex occurs above the nose. That is to say, sex begins in the brain. One might add, in a brain prepared by culture.
A woman who is having her breast manipulated for the purpose of discovering a malignant tumor is hardly in the mood for dalliance. And a physician who has seen breasts daily for years, who has seen breasts flayed open in the operating room and seen a rock-hard cancer in that tissue, is not likely to be turned on by his patient’s body.
The same is true for other body parts. As you go through medical school you realize it’s not the anatomical entity that has to do with sexual attraction.
Yet, back in the sexually liberated 1960s and ’70s, when I was a resident, the medical profession and society were not so sure that sex between doctors and patients was, under all circumstances, wrong.
One of my fellow residents saw a young woman in the emergency room for the flu. In the hallway, writing her prescriptions, he asked for a date and she accepted.
I was horrified.
“You can’t do that,” I told him.
“Why not?” “She’s a patient!” “She’s just a girl with a cold,” he said. “She’s a stewardess and she wants to go to the ballet.”
“But you examined her. She took her shirt off. People could say you looked over the goods.”
“I just listened to her lungs.”
“With her shirt off.”
He had to think a moment. “Yeah,” he admitted, “she did take her shirt off. So what?”
For him, seeing a woman’s chest had no sexual content. He had asked her out not because of what he had seen, but because of other, much more complex interactions.
But I thought he was wrong then, and I still do today. Not because I imagined the woman had been wronged, but because I thought it was a bad practice. The next patient may not feel as this woman did. For me it was an issue of policy.
Among most doctors today, sexual misbehavior is, at best, a footnote. The strictures of the profession have turned into a form of public posturing at which many physicians privately scoff.
But what all this emphasizes is the distance that society demands of its physicians on the one hand while condemning it on the other.
The image of doctors as potential lovers is a staple of soap operas precisely because romance with patients is forbidden fruit. The doctor is not supposed to be interested. His mind should be on higher things.
Americans want their doctors to be people of uncommon intellect, exceptional achievement and remarkable emotional detachment who are willing to work in increasingly restricted and difficult circumstances.
Oh, well. They always told us during the long nights of internship that medicine wasn’t supposed to be an easy profession.
— DR. NEIL RAVIN is an endocrinologist.
