Scripted Role Play on sexual harassment of doctors by patients

The findings of a survey of 180 doctors by Melbourne and Monash Universities hit the media in Oct 2013 after being published in MJA. The survey results showed that 55% of Australian female GPs had been sexually harassed by patients and 65% been asked for inappropriate examination. It was stated that less than 7 per cent of the GPs  surveyed said they had been trained on how to deal with sexual harassment by a patient.

Reading the report prompted me to consider how we could cover this with trainees and thought that a scripted role play (*see explanation below) may be an effective method to broach this difficult topic.  I wrote the short script below to use with GP registrars.
Please feel free to use and/or adapt it if you wish.  All I ask is that appropriate attribution is made and that you let me know how it goes if you do run it with students or junior doctors. I always appreciate receiving feedback.

* Explanation

Scripted and semi-scripted role plays (where dialogue is initially read rather than improvised) can be less threatening.  They provide most of the educational advantages of traditional role plays (e.g. experiential learning, development of empathy) while eliminating or reducing many of the limitations (e.g. lack of control over subject matter, quality of information imparted, performance anxiety), making them a more accessible and palatable option.

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Scripted Role Play Material is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.

Workshop structure (approx. 30mins):  

1)   Prior to the session, two volunteers are sought for reading role play (and permission is obtained – no one is ever pressured to read).  I would suggest the roles are played by two females to minimise any discomfort, given the material.

2)  Introduction to session

3)  Scenario (projected via PowerPoint and/or read aloud)

4)  Reading of dialogue by volunteers with break midway (as per script) for discussion

5)  Facilitator-led Q and A “in role” – which may involve some “re-winding” / additional role play by same or new volunteers.

6)  Exercise to “de-role” readers

7)  Group discussion

8)  Conclusion

Scenario:

Dr Emma consults with new patient, 72 year old Fred Jackson.

Script: 

Emma:  (At doorway) Fred Jackson?

(Emma comes in with Fred, an elderly man.)

Emma:  (holding out her hand to shake) Hello Mr Jackson, my name is Emma Roberts. Welcome to the clinic.

Fred:  Well hello Emma, aren’t you a sweet little thing?

(Fred shakes with his R hand and uses his L hand to stroke Emma’s forearm. She withdraws it quickly without any fuss or change in facial expression and motions for Fred to sit. They both sit down.  Fred edges his chair a little closer to Emma’s. She edges hers back slightly)

Emma:  How can I help you today, Mr Jackson?

Fred:  No need for the formalities, darlin’, we’re all friends here.  I’m been Freddie since the day I was born, seventy-two years ago today.

Emma:  Happy birthday, Freddie.

Fred:  It’s all the more happy now I’ve seen you, darlin’. You’re the kinda present I’d love to unwrap. Tasty! (drawn out pronunciation: Taste-ee)

Emma:  Let’s focus on health matters, shall we?

Fred:  I’m just having a bit of fun, darlin’. I don’t mean nothin’ by it. You wouldn’t begrudge an old man a bit o’ harmless fun on his birthday, now would ya love?

Emma:  I’d feel more comfortable without that kind of banter, if that’s OK.

Fred:  You’re a bit uptight, aren’t ya love?  No worries, I’ll tone it down.

Emma:  So what can I do for you today?

Fred:  I know what I’d LIKE you to do for me, with those soft white hands and rosy red….

Emma:   (interrupting) Freddie, that is inappropriate.

Fred:  Sorry, sorry.  Don’t get your cute little knickers in a twist. I’ll behave.  OK, well it’s kinda embarrassing. I’ve bin havin’ problems with me waterworks. No longer Niagara Falls, more like a pissy little dribble that won’t even put out unless you talk to it real nice and buy it dinner first. (laughs at his joke)  Me regular doc reckoned it is probably me prostate and wanted to stick a finger up me bum to check it out. I told him, no way any bloke is putting any of his bits in my hole – just doesn’t feel right, ya know love?

Emma:  It’s a routine medical examination, Freddie, there is nothing sexual about it.

Fred:  Maybe, but I’d feel a lot better if a nice young lady doctor did it. You’ll treat me gentle, I can tell.  Might even be fun, and God knows, I don’t get much of that kinda fun anymore.

Stop:

Discussion:  How do you think Emma is feeling right now?  Why is Freddie behaving this way? (dirty old man, inappropriate but harmless/ well meaning or someone  who is trying to cover up his embarrassment with “humour”) How has Emma handled things so far? What would you have done differently? What can she do now? Get volunteers to say what they think Emma’s next response should be)

Emma:  First, I’ll need to take a full history and perform a general examination. If I agree that a rectal examination is indicated, I will ask my colleague, Dr Michael Harris to come in and act as chaperone.

Fred:  We don’t need no chaperone, darl. I trust ya. I’ll put my bum in your hands anyday.

Emma:  It is for my comfort as much as yours, Freddie. It is my policy not to perform that kind of examination without someone else present.

Fred:  How about a sexy nurse then?  Always fancied a threesome.

Emma:  Again, I must warn you about your language, Freddie. I find it offensive and if you continue, I’m going to have to ask you to leave.

Fred:  Sorry love. I’m harmless. Just like joking around.

Emma:  If are not comfortable with Dr Harris being present, and you need an intimate examination, I’m afraid I’ll have to ask you to go elsewhere for the examination. I’d be happy to pass on any relevant information to the doctor of your choosing.

Fred:  Blimey!  Are you some kind of bloke-hating women’s libber? Talk about overreacting to a bit of friendly chat.

Stop:

Q and A in role 

De-role readers

Group Discussion:  Has anyone experienced inappropriate sexual behaviour from patients? How did you handle it? Stats (55% GPs 2013 study) What are your options? What systems in place in your practice?

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