With this report, we wade into even murkier waters: Sexual impropriety. The Medical Council of New Zealand describes this category of offense as non-physical behavior that is "disrespectful in manner and sexually demeaning." This encompasses dirty jokes, sexual innuendo, crude gestures, vulgar suggestions, or unseemly comments of a sexual nature -- anything that might be interpreted (or even misinterpreted) as sexual.

Although the category may seem broad and vague, most men can recognize sexually charged speech (we continue use of the male pronoun because the vast majority of these cases involve male doctors).

The problem often arises from men being unaware, or unwilling to admit, that such speech may be offensive or threatening to women. They may be used to such talk with their friends, colleagues and social acquaintances, and fail to keep in mind the context of their talk with patients. This is particularly difficult with doctors of chiropractic, who often form friendly relationships with patients.

But, while an offhand sexual remark to a spouse or "significant other" may be considered merely friendly banter, it can make female patients uncomfortable and therefore leave the doctor vulnerable to a complaint. This is true for any overly familiar conversation involving sex, romance, body parts or intimate apparel or any body language that might convey a sexual interest in the patient.

Some medical governing boards have developed a list of behaviors they feel can be interpreted as sexual impropriety. The College of Physicians and Surgeons of Manitoba, for instance, came up with these items:

*** lack of respect for patient privacy, i.e. overexposing the patient's body during examination with no gown or drape sheet provided

*** little or no explanation prior to sensitive examinations, i.e., breast or genital examinations; procedures that differ from previous examinations

*** sexually suggestive, demeaning comments or language

*** dirty jokes

*** unnecessary discussion of a patient's sex life

*** ogling (eyeing up and down), excessive flattery of a patient's physical appearance

*** discussion of the physician's sex life

Naturally, the situations involving disrobing or breast and genital examinations would never (or should never) arise in a chiropractic office, but the others are all potential problem areas for any D.C.

To eliminate almost all chance of sexual impropriety complaints, male doctors should see female patients only in the presence of a female "chaperon." However, this isn't always possible or practical. In that case, the doctor must be careful to cultivate what the "Sexual Boundary Policies and Processes: Evaluation and Action Plan" considers important competencies:

*** Appropriate eye contact with the patient

*** Sensitivity to verbal and non-verbal clues

*** Consideration of patient's beliefs, feelings

*** Appreciation of the social context

*** Patient consent clearly obtained for any procedures.

By making sure you draw very firm boundaries around your speech as well as your actions, you will prevent most of these problems.

If you're ever tempted to let down your guard, remember the warning given by the New Hampshire Board of Medicine: "Few physicians believe that they are or can be threatening to their patients. But, as any doctor who has had complaints of this nature lodged against them can tell you, it is very hard to know, in advance, who may be offended by your behavior."

SOURCES: The Medical Council of New Zealand, The "Sexual Boundary Policies and Processes: Evaluation and Action Plan" 2002.

The Medical Council of New Zealand "Statement on Sexual Abuse in the Doctor/Patient Relationship," June 1994.