Sexual boundary issues among physicians-
A continuing medical education course

Sexual boundary violations with patients are an emerging and serious behavior problem among physicians, and thanks in part to support from AFAR, a new Vanderbilt University course is helping address it.

"A few years ago, we began to notice that some participants in our course for physicians who have misprescribed Schedule II narcotics revealed that they had also had sexual boundary problems," said Dr. Anderson Spickard, Director of Vanderbilt's Center for Professional Health. "We began to realize that there was a need for a course that would help such physicians address this problem. As we began development work, we also discovered that few, if any, physicians had been adequately taught about sexual boundary issues in medical school, nor were they aware of the AMA's guidelines in this matter." Thanks to a relationship with David Dodd, the Emeritus Director of the Tennessee Physicians Wellness Program, Dr. Spickard enlisted the help of Patrick Carnes, Ph.D., Jennifer Schneider, M.D., Ph.D. Elizabeth Griffin, M.A., and Richard Irons, Ph.D., all experts in the field of sexual compulsivity. "A grant from AFAR enabled us to further embellish the course," he said, "which we have now offered for more than a year."

Entitled Maintaining Proper Boundaries, the course was developed specifically to help state Boards of Medical Examiners respond to physicians who are having difficulty with boundary issues but who have not engaged in criminal behavior. Re-education in a continuing medical education (CME) course is provided for physicians without a major sanction against their license to practice and for physicians who are returning from treatment and planning to return to practice. Boards of Medical Examiners find this course appropriate for physicians who need a disciplinary action less severe than licensure revocation but stronger than a simple warning. Treatment centers may also refer physicians to the course to assist them in relapse prevention, reentry to practice, and development of proper office procedures.

Limited to ten participants, the three-day course combines traditional didactic instruction, confrontation, personal examination, and practical problem solving. It emphasizes the following goals for physician attendees:

• Understanding sexual boundary issues and promotion of prevention, detection and treatment of sexual addiction.
• Discussion of healthy sexuality and appropriate boundaries among staff, colleagues, and patients.
• Identification of risk factors in the education and training of physicians who have violated sexual boundaries.
• Review the socialization in medical school and residency training that may contribute to boundary violations.
• Identify family of origin issues and core personality factors that may contribute to sexual boundary violations.
• Review office organization and policies that establish non-sexual and sexual boundaries.
• Identification of appropriate treatment resources in the U.S.

According to Dr. Spickard, the physicians who have attended the course give it high marks. "In course evaluations, participants say that the course content was extremely valuable and that many were not aware of some of the practices, particularly in office procedures, that led them to be more susceptible to this behavior," he said. As more state Boards of Medical Examiners become aware of this course, the Center for Professional Health hopes to offer it every other month on an ongoing basis.

Maintaining Proper Boundaries is offered throughout the year. For information, contact:
The Center for Professional Health, Vanderbilt University Medical Center, 1107 Oxford House, Nashville, TN 37232-4300. Phone: 615-936-0678. E-mail: cph@mcmail.vanderbilt.edu