HOW Misconduct Occurs
One of the desert fathers, living his ascetic life many centuries ago, said that if one thinks of fornication one can avoid committing it, whereas if one fails to give sufficient consideration one invariably winds up in the wrong bed. Abba Cyrus of Alexandria was no stranger, it seems, to the dangers of allowU+00A ing powerful drives to remain hidden in the unconscious mind. 1
Sexual misconduct usually begins with a very minor violation of doctor/patient boundaries--a first step on "the slippery slope," as Linda Bowers puts it in her eponymous article about boundary issues in the doctor/patient relationship. 2 Few health-care professionals intend any impropriety. But the boundary violations that constitute sexual misconduct can begin very slowly, with apparently harmless deviations from standard procedures. A doctor may bend the rules a little bit, then a little more, until the little deviations have added up to something far from harmless.
Minor violations often set the stage for the further rationalizing of one's behavior--that is, for kidding oneself. What can a health-care practitioner do to avoid inadvertently becoming involved in such a situation? Awareness of the breakdown of professionalism is one of the major keys to avoidance.
There are many ways in which the professional boundaries can fail. "Transforming the relationship to meet the [professional]'s needs is the core exploitative quality. Sex is merely one possible exploitative outcome, notewothy because it is more noticed." 3 The following are only a few of many possible examples, 4 but when a practitioner begins to act in any of these ways,