Page 6 - Volume 70 Number 2
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ensure a dominant-supplicant dynamic.
The patients -- elite athletes and Olympic gymnasts
-- and were especially vulnerable. The stakes were very high as they were usually in tight competition for a limited number of places. For many, it is often a once-in- a-lifetime proposition since the chances are that they may not hit peak form again to vie for a chance in the next Olympiad if they miss the cut this time. It is there- fore easy to appreciate the allure of manipulations and other procedures of dubious merit peddled as perfor- mance-enhancing, pain-relieving or curative, especially in our culture that highly valorizes athletic prowess.
At least two things went wrong in the case of the US Olympic gymnasts and their doctor, namely disregard for fundamental professional etiquette and supervisory failure. In the earliest days of clinical training, medical students are taught that a chaperone, preferably a clinic staff person, should be present during any physical examination in which the patient is required to disrobe in gender-incongruent encounters. The presence of an appropriate third party would not only reassure the patient but also keep the doctor properly focused and afford her a source of corroborative independent testimony should a dispute arise. It is surprising that a doctor would fail to adhere to so simple an expedient,
considering how much controversy it would spare him, his institution, the profession and society at large.
As physicians, we have an obligation to ensure that our relationship with our patients is beyond reproach, given the trust they repose in us. We should also take complaints of abuse seriously. Although the initial impulse might be to circle the wagons, complaints of impropriety ought to be promptly and well investigated. If substantiated, appropriate remedial action must be taken equally promptly. We all do well to remain constantly mindful to our professional ethical responsibilities in our interactions with our patients.
In this message, I have touched upon two kinds of abuse in our community, that of opioids by patients and that of young female athletes by a physician. In response to the first kind, the medical community and government agencies at all levels, county to federal, have mobilized to meet the challenge. Regarding the second kind of abuse, one rotten apple has been identified and is currently serving up to 300 years in prison and one other identified. It is troubling however that members of the profession were complicit in allowing this abuse to continue for two decades, during which time an estimated 265 young women and girls were victimized. There is more work to do on that front.
 6 Washtenaw County Medical Society BULLETIN APRIL / MAY / JUNE 2018

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