Over the past several months (maybe 12-18) there has been a concerning trend among our female DPC colleagues. We have seen a noticeable uptick in reports of inappropriate sexual advances, from sexual harassment to concerns of impending sexual assault. It’s unclear whether this increase is due to an actual increase in events, or an increase in reports, but either way, it’s not good.

For a specific example, those of you who are members of the DPC Women Facebook community likely recall a post from a few months ago about a major safety concern.  For those who are not members, I shall paraphrase the concern here.  A male patient contacted a female DPC physician asking to be seen in her office. He refused to provide key pieces of identifying information, like his address, and had a valid explanation for not supplying that information. He further refused to establish himself as a DPC patient and was only interested in a one-time visit (which this physician did offer and had on her website at the time). Over the course of the conversation, the physician felt like something was off, so she had her husband present in the office when this patient arrived. Throughout the course of the evaluation, it came out that he had traveled over 2 hours and was there specifically for a GU exam (without GU-specific health concerns).

Feeling very unsettled by the situation, she reached out to colleagues and came to discover that several of our colleagues across the state have had similar experiences. Slight changes in details here and there, but the overall gist was the same. Now the question became what can we do about it. We spoke to people at all levels of the legal system to figure this out, and I’d like to share what we’ve learned.

But, before I dive into what we learned, I want to clarify that I know not all sexual predators are male, and not all victims are female. These suggestions apply equally across all demographics and are intended to help us keep ourselves and each other safe.

1. HIPAA Laws do NOT protect sexual predators.  As physicians, we are taught to never (and I mean NEVER) share the name of your patients with anyone for fear of the all-mighty HIPAA Laws. After speaking with several lawyers, the consensus is that if you have a very unsettling experience with a patient, and you have real cause to fear for the safety of your colleagues, you can share the name for their protection. You cannot share any medical details – but if you can prove that you had reason to believe the patient was a threat to a colleague you can share names.
2. Without any physical threats, or public indecency, the local police cannot do much (if anything) to help.  We were advised to file reports with the state police as this was a repeat offender covering large areas of the state.  The state police are better equipped to monitor and investigate this than each local precinct. Unfortunately, because this behavior is happening in the confines of a medical exam room, it’s not an easy case to build.
3. It’s best practice to have a security camera at your entrance (ensure that it is HIPAA compliant – meaning not overlooking patient care areas and not able to view PHI), and scan a photo ID of all patients at the first visit. These will provide positive identification of the perpetrator should you need it. Without these, all the police have to go on is a name that may or may not be accurate and a description that likely describes thousands of people.
4. Utilize whatever resources you have at your disposal to alert your colleagues. In PA we reached out to the PAFP who posted an alert to all members in their membership publications with tips on what to look for and how to file a report should they need to. Did it help? Hopefully. If it prevents even 1 person from falling victim to this predator or another one, it helped. If you have access to secret physician-only Facebook groups, alert people there (I wouldn’t share names on social media, but a notice of your encounter with a “please reach out” and share names in private if needed). With this incident, one of our colleagues notified us on the PA DPC Physicians Facebook group which is how we realized how widespread his reach was (to be clear – the outreach was done in such a way that it did not violate HIPAA laws).
5. Remain vigilant and trust your instincts.  Remember that most sexual predators are experienced. They’ve done this before. Hopefully, you are not. Watch for warning signs – someone who seems too nice or too helpful, someone who pushes too hard to not follow protocol (ie “come on doc – is all this really necessary?” during check-in), someone who dodges “personal” questions (like refusing to give an address to a physician’s office), the list goes on and sadly most women know it very well (anyone, male or female, who doesn’t I’m happy to educate you). If something seems amiss, if you’re seeing red flags, or even just feeling unsettled, do not approach the situation if you can avoid it.  If you must approach, do not do so alone.  Have witnesses or a panic alarm or something available for your safety.
6. Being a DPC physician, especially female, will make you appear to be an easy target. Many of us start alone or with a single staff member and there are those that will take advantage. Patients are not the only potential predators; vendors, couriers, sales representatives, and even other physicians have been known to sexually harass. Don’t let your guard down based solely on someone’s profession. 
7. If you find yourself the victim of such acts, you don’t have to suffer alone. Many of our colleagues are willing to help, even if it’s just providing a sympathetic ear. And sharing your story may help protect others. If you need help connecting with trustworthy supportive colleagues, please reach out to me via Facebook or email ([email protected]).
8. Finally, if someone else tells you they are being sexually harassed believe them. If you have a receptionist who is uncomfortable around your lab courier, there is likely a reason.  Provide a safe space for them in any way you can. That may mean banning certain drug reps from your office, or calling your lab and demanding a different courier (I know of instances where both of these were required). The correct answer is never “I’m sure [he/she/they] didn’t mean anything by it” or “you’re overreacting”.