Sex with patients

The incident

One day my colleague told me that she had slept with a patient and not just one patient. She had already had sex with a patient from Hungary, one from Colombia, one from… She seemed to have already drawn up a list of patients from different countries she had sex with. I was shocked and I could not believe it. First of all, how unethical. It is simply impossible to have relations with patients. Secondly, why would she tell me? I told her straight away that this is impossible, but she did not really understand me. She told me: “You know in Peru I could never behave like that but now that I am here, I can dress differently and this is all not a problem. I have become a European.” I was really disturbed by her rationale. I am a South-American woman as well but I do not behave like that. Moreover, not all Austrians go and have sex with patients or will sleep with different persons every week. So I was quite annoyed with her because it is simply not true what she was insinuating. There are rules in a liberal society as well.

After that incident working with her was quite difficult and finally we chose to close her contract.

1. Identities of the actors in the situation

Narrator

Married woman with six children, living in Austria since for more than 20 years and born and raised in Mexico; 59 years old; practicing Catholic; highly educated; works in the doctor’s office of her husband; very international life (lived in different countries);

Assistant from Peru

31 year old doctor’s assistant; born and raised in Peru; living in Austria for 4 years; Catholic; single; heterosexual;

Indirectly involved actors:

Husband / doctor heading the office

General practitioner; Austrian with Hungarian ancestors; married; 6 children; head of general practitioner’s office

 

Patients of different national origins whom the assistant had sex with

The two main actors, the narrator and her colleague, are both females living in Vienna, working as doctor’s assistants, having been raised in a South-American country. Both were raised Catholic and identify themselves as heterosexuals. The narrator is thirty years older than her colleague and she has been living in Austria for a considerably longer period. She is married with children while her colleague is single. Furthermore, the colleague is a typical employee while the narrator is married to the doctor who leads the practice, which makes her a lot more invested in this place of work and positions her hierarchically above her colleague.

2. Context of the situation

The incident occurred among employees of a general practitioner’s office in Vienna. The head of the office is the narrator’s husband. The practice focuses on international clients and there are about 5000 patients from all over the world. In 4 years of practice the doctor had over 24 employees (fast overturn) – male and female, with different national and cultural backgrounds. The narrator communicates that many professionals cannot handle working in such an international practice with diverse patients who cannot speak German. Many reported being overwhelmed or exhibited an unfriendly attitude towards patients.

Before the incident there was no conflict between the narrator and her colleague and they engaged in a friendly relationship.

The narrator considers herself a migrant, having been confronted with stereotypical and often derogatory representations of South-American women while living in Austria. She herself holds a very positive view on migration and multilingualism.

3. Emotional reaction

Annoyed; astonished; disturbed.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock

Sexual norms:

  • Monogamy or at least not quick overturn of sexual partners
  • Sex is connected to partnerships, emotions and love.
  • Sex ideally happens within the context of marriage.
  • If one is sexually promiscuous, one does not flaunt his or her adventures.
  • Sexual encounters are not something one should collect, especially not on the basis of a criteria like nationality of the partner.
  • Professional conduct can regulate sexual behaviour, as in the context of the patient – medical staff relationships: professional ethics supersede individual desires.

 

Ethics in medical / professional practice:

  • No sex with patients: Sex with patients is considered unethical, because medical staff can capitalise on their professional position, exploit the patient’s vulnerabilities and thereby cause a loss of trust in the medical profession.
  • Specific norms on how to conduct professional relationships: not only in regard to dealing with patients, but also concerning interactions with colleagues. The sharing of an unethical practice puts the narrator in an awkward position. She prefers not knowing what is going on over open communication on a delicate subject matter.
  • Prioritisation of a professional relationship between colleagues in a place of work over a personal relationship.
  • Unethical behaviour by staff challenges the practice’s reputation and in consequence the professional standing of the narrator’s husband.

 

Degrees of acculturation – keeping in touch with one’s pre-migratory upbringing:

  • Values should not be changed easily due to migration: Preference of holding on to certain elements of the old value system over totally assimilating to what is thought to be the value system of the new country.
  • By being addressed as a fellow South-American woman the narrator’s self-image was threatened: need for boundary-drawing between her and the assistant.

 

Non-cultural view of values:

  • Ethical behaviour is not so much context dependent but hinges on the individual person. While the narrator does attribute some of the values she holds to her Catholic upbringing and belief system, she also challenges the notion that people from the same background must share the same values.
  • Challenging of group stereotypes / individualist orientation: Invoking cultural difference is no excuse for inconsiderate / unethical behaviour. It is still the individual person who decides how to act.

There are rules both within liberal and more traditional societies and order is not dependent upon more traditional forms of social organisation.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

Unethical, promiscuous, naive

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator

Openness to new cultural experiences:

  • Life in Austria is experienced as liberating compared to life in Peru because there seem to be more options available on how one can behave.
  • The assistant shows willingness to assimilate and shed constrictive rules she learned during her socialisation.
  • One way on how to integrate into a new society is via social (sexual) relations. Sexual relations can be interpreted as an effort to connect culturally.
  • Values and codes of conduct do not have to be rigid but can rather be tried out in a playful way.
  • Orientation towards negotiating codes of conduct – also within the workplace and among colleagues.

Orientation towards social connection:

  • Making a connection with the new society is key.
  • The assistant is talking to the narrator as friend, confidante and not as colleague – prioritisation of personal relationship instead of professional. Sharing and becoming emotionally close is seen as an opportunity to establish a connection.
  • On the one hand, holding a job and being considered a professional is maybe not as important as establishing a close relationship. On the other hand, sharing information about sex with patients might not be considered as being unprofessional.

Sexual liberties:

  • Especially as a woman who might not have experienced these liberties before; no need to confide the sexual to romantic relationships.
  • Focus on desire, spontaneity and making new experiences.

Ethics in professional practice:

  • Two consenting adults having sex does not infringe on ethical medical practice.
  • Distinction between professional self and private self: what she does on her own time is not to be judged by her co-workers.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

Implicit vs. explicit code of conduct within health care institutions

  • Spelling out what is considered ethical practice for health care workers in order to obtain explicit codes of conduct which orient behaviour.
  • Problem of overregulation: Codes of conduct can never be all-encompassing and if they are they are experienced as debilitating. Instead, general guidelines of ethical practice should go along with establishing a reflective professional culture where ethical dilemmas and potential solutions can be discussed amongst co-workers.
  • Developing guidelines and establishing communication about professional culture is especially relevant in transcultural work settings where different expectations and implicit norms co-exist and potentially collide.
  • Thinking about a code of conduct starts processes of institutional discussion, thereby not only addressing standards of professionalism and ethical practice, but enhancing participation of all staff members on an institutional level.

Working in transcultural teams

  • In the health sector people from different cultural backgrounds, with different experiences of migration, routinely work together in transcultural teams. While personal experience of cultural transition often enhances transcultural competence and working across multiple social and cultural divides, issues of differing approaches to acculturation as well as expectations towards group similarities can give rise to conflict among co-workers – as illustrated in this critical incident.
  • Cultural identities can further collide within elements of work culture, pointing to training needs of how to work in transcultural teams in the specific context of health care institutions.