Dr. Joel Aronowitz - A Conversation with a Forensic Psychologist about Medical Ethics behind the Exam Room Doors
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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: Hi, everyone. I'm Dr. Joel Aronowitz and welcome back to our channel. Today, I have something a little bit different. This is a conversation from the exam room with a woman who's a forensic psychologist. It's a very interesting field. You may know something about it, maybe more about it than I do, but I thought it was interesting to have a chat with her about the aspects of forensic psychology that overlap with what goes on behind closed doors in an exam room.
This is kind of a touchy subject, but it's something that both the providers in medicine, doctors, nurses, PAs, and actually anyone who finds themselves in an exam room with a patient, should be aware of and should be cognizant of the various issues, as well as for patients. So, I thought I would share this conversation with you. I hope you find it as interesting as I did.
Let me know if you like this sort of content. If you have any questions or comments, please leave them below for me. Thanks. Works anywhere within the legal system, applying psychological principles to try to answer legal questions. So, for example, I get a parking ticket, and they say I really, really, really needed to park there because it makes me anxious not to have a parking spot, and you would come and defend me, or something more serious. Well, potentially, I'm not sure that that excuse is going to fly.
And I was telling you about a case that I actually testified in of a doctor who was doing funny stuff, recording patients in the exam room and then using their recordings for their own purposes. So, if you're a patient, how can you tell? What should make you suspicious if there's something weird going on, on some non-professional level, sexual or some other, for lack of a better word, perverted thing going on?
Forensic Psychologist: Well, that's the thing. You don't always know. You don't know. So, I've had cases with gynecologists that sexually touch their patients, anesthesiologists that sexually touch their patients. Just about any kind of physician can have some kind of issue in this case where you probably have a voyeur that's putting cameras in there. So you can't always tell.
But I think the most important thing is what we see in terms of victim behaviors is that people don't tend to report this right away. They're afraid. And this is how physicians who do become sexually inappropriate with their patients, they're able to accomplish that because they're in a position of power and authority already. I don't feel like I'm in power, but I understand what you mean. Right. And so we're kind of brought up to not question a doctor.
That's changing. It's certainly changing over the last 20, 30 years. But we're brought up not to question physicians, not to question people who have advanced medical degrees, so people don't tend to come forward.
Dr. Joel Aronowitz: Well, if we've learned anything over the last three years, it's to question those with advanced degrees. But so, let me ask you this. Is it always a male victimizing a female, or is it female-female or the other way around?
Forensic Psychologist: Well, it's usually male. Ninety-five percent of the time, it's male. And in my experience, I haven't had any female physicians brought up in any kind of inappropriate sexual things. But it's males. And the reason for that is 95 percent males because males have testosterone and testosterone fuels sexual behavior.
Dr. Joel Aronowitz: So, so just women also have testosterone, and women and women. You can size up the relative testosterone level of a group like you work with 15 people, and you have people rate them. You know, the coworkers, the relative testosterone levels line up very, very well, actually. So it couldn't be just testosterone. But I hear what you're saying in terms of the sex, the sexual drive.
Forensic Psychologist: Exactly. And women do. You know, we hear about women teachers and things like that. So women do, but they tend to do it for more emotional reasons than sexual.
Dr. Joel Aronowitz: So then, if you're a woman and you're going to see the doctor and you're going to go see a male doctor and you're going to disrobe or you're going to be in a, you know, a position where you don't have all your clothes on, or, you know, there's some intimate examination kind of thing going on, what should, you know, should you worry about that? And what should what are any triggers that you should take as indicators or something else going on?
Forensic Psychologist: Well, I think number one, the most important thing is there always should be a female chaperone inside the room whenever you're disrobing to any extent.
Dr. Joel Aronowitz: Yeah. And I tell all the doctor trainees and colleagues, you know, that is standard of care now is if you're in the room alone with a patient, actually could be a man or a woman, you shouldn't be alone. You should have a chaperone there for everybody's benefit.
Forensic Psychologist: Right. And I would also say, I would also add, just based on my experience with the cases I've been involved with, that if, like, for instance, when you're in with a gynecologist, sometimes the gynecologist will be in front of you this way with a blanket or whatever kind of tissue paper. And then the chaperone will be behind you. I would say, 'Oh, would you mind moving over there?' and having the chaperone be able to actually physically put eyes on what is happening.
Because in some of the cases I've been involved with, it's been happening behind the curtain, so to speak. And there are other people in the room, which also makes it more difficult to say, 'Hey, this happened to me.' There are people around. So, and I think patients just have to be more proactive about it. And it's difficult. It's difficult. But I think if you at the beginning say, 'Hey, oh, would you mind sitting over here? I don't mind if we're over here.' Just something like that at the beginning and make sure that the chaperone is watching everything that's taking place. And I think that's the best way to ensure that nothing is going to happen. But in terms of cameras, honestly, I don't know what you can do because there's so many ways that you can put cameras in. And that's so rare. I think it's also important to realize that most of this stuff is very rare. The chances of it happening are very slim.
Dr. Joel Aronowitz: Yeah, that's a good point. In the case I was involved in where there were cameras, it was obvious that the doctor was moving the patient around in such a way and there were a lot of mirrors that, you know, there was something organized about it. So, a lot of our viewers, a lot of people that follow our channel are doctors, they're nurses, they're PAs, they're people on their path, that career path, they're wannabes. What would you tell a young doctor or trainee about avoiding this problem? Because it's sort of a thing that if you're accused of something, it would be absolutely devastating, both personally and professionally. It would be just professional destruction, and you want to protect yourself from that kind of accusation. What would you tell them? What kind of advice?
Forensic Psychologist: I think the best advice is to always have a chaperone in the room. That is the number one best advice. If you're rushing, if you're late, I understand, oh, I don't have time, or I've got the next patient to get to, or whatever. Do not let that person be in any kind of state of undress without a chaperone present, physically watching everything that you do. And I've been in situations where I've had a sign that I'm aware that a chaperone needs to be in the room, and all that, as a patient.
So, that's another way to protect yourself. So always have a chaperone and document that. And I'm trying to think of anything else. I think just keep the professional boundaries. Otherwise, I think it's always, I always enjoy being in an office that's friendly, and I feel at home. But just, just watch your professional boundaries. And then also, plastic surgeons are very good at kind of assessing some of the psychology.
I think they're better than a lot of physicians. But, you know, if you have someone that you can tell, you know, has some psychological problems and is mainly seeking plastic surgery to fix themselves emotionally, then maybe that's a person that you need to be extra careful with.
Dr. Joel Aronowitz: Yeah, I think along those lines, I would say, you know, I don't actually don't know any dirty jokes anymore. But I don't. I tell stupid ones, you know, dad jokes to lighten things up like, you know, what did the fish say when he swam into the cement wall? You know, just dumb popsicle stick jokes if I need to lighten things up. But I never tell sexual jokes, and I don't make sexual remarks. And I try to not really flirt in that context, you know, in the exam room, which is especially when you're younger and there's more sexual tension that goes on.
I try to not, if I'm feeling like the patient is massaging my ego, so to speak, and I'm feeling good, or I'm, you know, there's something sexual going on, it alerts me that, wait, something's wrong because the patient shouldn't be making me feel good about myself. And I shouldn't, you know, they shouldn't be making me be interested in me socially and that kind of thing.
So, those sort of things, when you're getting some nonprofessional vibe, it's a good time to back up and take a deep breath and figure out what's going on, or step out of the room and let it deflate a little bit because that happens, especially the younger doctors. There's another nonsexual thing called Munchausen, which I'm sure you're well aware of, that young doctors see actually very frequently because those patients see those patients go to young doctors, and they kind of pump you out.
And then all of a sudden, you know, and it's like, oh, yeah, I'm the hero. And no, you're not the hero. You're just another doctor. And there's a reason, you know, you're they're pumping you up.
Forensic Psychologist: Well, that's right. And I'll just add quickly along those lines. I think it's really important to, like you're saying, monitor your own feelings. If you're feeling sexual attraction towards your patient, then that's a major red flag.
That's what they always taught us. Which will happen to you if you're honest with yourself. Always. As a psychologist, it happens too. It happens in every professional relationship. There's nothing wrong with it. It's just a signal that you have to pay attention to. And then the other thing that I've seen because I've seen more psychologists blow their career because it's just what I do for a living on, you know, sexual inappropriateness, is taking care of yourself emotionally because it's your loneliness that's going to drop those boundaries.
It's those loneliness needs that you're not paying attention to, not necessarily even the sexual ones, but it's the loneliness ones. And like you're saying, the ego and feeding your ego, try to fill your loneliness that way.
Dr. Joel Aronowitz: Get a dog.
Forensic Psychologist: Exactly. Take care of yourself that way, and you'll stay out of trouble.
Dr. Joel Aronowitz: And if you're like me, just deep down, you're shallow.
-Thank you so much for sharing all that. Thank you.
Dr. Joel Aronowitz: What an interesting career. Thank you. If somebody wants to be a forensic psychologist, how would they go about that?
Forensic Psychologist: Well, you get a Ph.D., you can get a Psy.D., which is a doctor of psychology. You have got a doctor of philosophy in psychology, and you just go and get experience in forensic psychology. So, undergraduate, I worked at a variety of placements. I didn't do all forensic psychology. I worked at County USC. I worked at Long Beach VA Medical Center.
I worked at a couple of state hospitals. And then I specialized in forensic psychology in my pre-doctoral and my post-doctoral work.
Dr. Joel Aronowitz: But important to start at your earliest stages, express that interest and seek that experience.
Forensic Psychologist: A little bit. I think it's always good, and I'm sure it's true in your training as well, you have to be a good generalist before you're a good specialist. So the mistake I see a lot of forensic psychologists making is just doing only forensic or only working with criminals or only working at prisons.
Well, you see the gamut, like I saw conversion disorder, functional neurological disorder, just the other day. It's the second one in my career. You see these rare things.
Dr. Joel Aronowitz: Like Heidi, like the story, Heidi, where she can't walk because there's something, is that a conversion disorder? That doesn't make sense neurologically, but you're having neurological symptoms. It's a good movie if you want to see a conversion disorder, Heidi.
Thank you very much. I hope you all enjoyed that little chat. It's something a little different that comes up in plastic surgery, and it really overlaps a lot.
Forensic Psychologist: Thank you.
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