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Behind Closed Doors: Gender, Sexuality, and Touch in the Doctor/Patient Relationship

Richard S. Epstein, M.D.

Although numerous books have been published about boundary violations in mental health treatment, a text designed specifically for clinicians in physical medicine has been long overdue. Angelica Redleaf and Susan Baird have written such a text.

Clinicians such as internists, gynecologists, and chiropractors whose diagnostic and treatment procedures require the laying on of hands face a difficult and sensitive problem. They must continually strive to maintain a coherent professional intent and demeanor when they expose their patients' nakedness or touch them during procedures.

In a book that is clearly written and free of jargon, the authors explain many of the problems inherent in gender roles, sexuality, and the meaning of touch in the doctor-patient relationship. They provide a well-documented summary of the importance of the physician's role as a medical fiduciary and describe how this position of trust and power can be misused to the patient's detriment. They offer practical advice on safe approaches when touching patients during medical procedures. Finally, to help identify and correct potential boundary violations in the clinical setting, the authors present a series of helpful questionnaires for surveying health professionals, support staff, and patients about problematic behavior that may occur.

Behind Closed Doors is a good companion to many of the works in the mental health literature on boundary issues. It should be required reading for all clinicians who are required to do physical examinations and perform clinical procedures. Mental health professionals who work as part of a general medical or surgical team will also find this book of great value.

Footnotes

Dr. Epstein is adjunct professor of psychiatry at the Uniformed Services University of the Health Sciences and is in private practice in Bethesda, Maryland.

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