Laatste update: 21 april 2005
Pseudo professionele wetenschappelijke
publicaties
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‘De medicus en de min en hoe het verder ging’ Prof. dr. M. W. Hengeveld |
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‘De medicus en de min en hoe het verder
ging’: een ‘wetenschappelijk’ artikel van prof. dr. Michiel Hengeveld, over o.a.
seksueel grensoverschrijdend gedrag (GOG) binnen de gezondheidszorg,
gepubliceerd in
het Tijdschrift voor Seksuologie (TvS) in december
2003[1]. Prof. dr.
M.W. Hengeveld: · werkzaam als bijzonder hoogleraar Medische Seksuologie aan het Universitair Medisch Centrum (UMC) te Utrecht · psychiater en tevens seksuoloog NVVS · eerder: hoofd van de afdeling psychiatrie in het Erasmus Medisch Centrum te Rotterdam · een van de twee hoofdredacteuren van het Tijdschrift voor Seksuologie (TvS) De attitude van prof. Hengeveld die betreffend de problematiek seksueel grensoverschrijdend gedrag (GOG) door hulpverleners geenszins professioneel of correct kan worden genoemd, blijkt niet alleen maar uit zogenaamde wetenschappelijke bijdragen van hem. Prof. Hengeveld is tevens lid-arts van het Regionaal Tuchtcollege voor de Gezondheidszorg Den Haag. Als lid van het college beoordeelt hij klachten van patiënten/cliënten m.b.t. onzorgvuldig, onprofessioneel en onethisch gedrag van collega-psychiaters. Hierbij gaat het soms ook om klachten m.b.t. seksueel GOG. Dat hij ook bij het waarnemen van deze belangrijke taak waarbij een professionele, neutrale en zorgvuldige kijk op de zaak en handhaving van dezelfde van essentieel belang zijn, niet oordeelt op basis van professionaliteit en ethische correctheid, blijkt uit een medische tuchtklacht die u binnenkort, eveneens in de rubriek PSEUDO PROFESSIONEEL, aan zult treffen. Het gaat hierbij om een klacht tegen een psychiater uit de regio Dordrecht die door het tuchtcollege ongegrond werd verklaard, een oordeel waartoe prof. Hengeveld heeft bijgedragen. Wij zijn van mening dat professionaliteit en een ethisch correcte attitude ten grondslag zouden moeten liggen bij het voordragen van leden voor tuchtcolleges. Alhier blijkt de keuze helaas gevallen te zijn op een ‘kwaliteit’ die bij het verrichten van werkzaamheden voor een medisch tuchtcollege juist een criterium van uitsluiting dient te zijn: ‘het hebben van vooroordelen’. Deze ‘kwaliteit’ is niet van professionele aard en dient dan ook nooit gepaard te kunnen gaan met het dragen van grote verantwoordelijkheid waarvan bij het beoordelen van medische tuchtzaken sprake is. |
De lezer van onderstaand artikel dient de
gangbare definitie van de term ´wetenschappelijk´ eerst opnieuw te definiëren alvorens verder te gaan
lezen. ´Weten´ staat namelijk voor ´kennis´ en ´schappelijk´ voor ´redelijk´.
Van redelijke kennis is hier echter geen sprake. ´Wetenschappelijk´ dient hier
dan ook te worden opgevat als ´niet weten waar men het in alle onredelijkheid
over heeft´. Het woord aan de hoogleraar:
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Onderstaand treft u een Engelse vertaling van het artikel ‘De medicus en de min en hoe het verder ging’ van prof.
dr. M.W. Hengeveld aan, zoals
gepubliceerd in het Tijdschrift voor Seksuologie (TvS),
Jaargang 27, nr. 4, december 2003, ISSN: 0167-5915,
pp 201-205. Michiel Hengeveld
is werkzaam als bijzonder hoogleraar
Medische Seksuologie aan het Universitair Medisch Centrum (UMC) te Utrecht.
Hij is
psychiater, seksuoloog nvvs en hij was het
hoofd van de afdeling psychiatrie in het Erasmus
Medisch Centrum te Rotterdam. Hierna volgt
de vertaling van de redactie
van MdH: English
translation of the scientific article ‘The physician and love and how it went
on’, Journal of Sexology (the Dutch
scientific sexological journal), Jaargang 27, nr. 4, december 2003, ISSN: 0167-5915, pp 201-205. The author,
Prof. dr. M.H. Hengeveld, is a psychiatrist as well
as a sexologist. He is a member of the Dutch professional organization of
sexologists. Hengeveld was chief of the department
of psychiatry of the Erasmus Medisch Centrum in In this speech at the occasion of my farewell as
professor of Medical Sexology I discuss several aspects of the peculiar
relationship between physician and sexuality. One third to three quarters of
medical patients suffer from sexual problems. They prefer their physicians to
inquire after these problems, but physicians rarely do so. Although training
courses for students and registrars on sexology are often positively
evaluated, one may doubt their long-term effects. Moreover, the
discontinuation of all special chairs in sexology at the Dutch medical
faculties may threaten the existence of this education. A period of practical
training for registrars in various medical specialties might be more
effective and lead to the appointment of sexologists in their future general
hospitals. Finally,
some doubt is cast on the black-and-white division between ‘offender’ and
‘victim’. The balance of power is not always so clear in such situations.
But, be that as it may, a physician should never let himself be 'sexually
abused' by a patient. Ladies and gentlemen, The relationship between a medical physician and
sexuality is a remarkable one. This was the topic of my valedictory address:
the physician and sexuality. This was what I meant to say by using the title
‘The physician and love’ (Hengeveld, 1989) for my
speech which I gave almost 14 years ago when entering upon my duties of being
a special Professor of Medical Sexology. In that speech I opened the discussion on various
aspects of all our doings as physicians in relation to sexuality. Today I’d
like to have another look at that subject. How did it go with the
relationship between the physician and sexuality since then? The sexuality of the patient In comparison to 14 years ago there is more
knowledge on the sexuality of patients suffering from different kinds of
diseases. The psychologist Jos Vroege
under my guidance has developed a questionnaire with which sexual
dysfunctions could be traced and measured. The questionnaire has been used in
a number of investigations in the A special PhD investigation which I was asked to
oversee was of Claudia Gamel who worked at the
department of the sciences of nursing at the Medical Centre of the University
of Utrecht (UMC). She graduated with a PhD thesis on a sexological
intervention done by nurses on women after having been treated for gynaecological
cancer (Gamel, 2000). A group of patients then lacking in my speech were
psychiatric patients. Back in 1989 only little was published on that topic.
In the meantime the psychiatrist Marcel Waldinger
took his degree with research on the effects of antidepressants on the sexual
functioning of a male (Waldinger, 1997). Next month
Rikus Knegtering, a
psychiatrist, will graduate in A new topic also is concern for the sexual
functioning of handicapped patients. Only in 1996 was the first good
investigation on this topic published (Nosek et al,
1996). In a recent edition of the Dutch Journal of Sexology an overview was
given of literature on the sexuality of handicapped adolescents (van Berlo & van der Put, 2003). Dutch as well as investigations from abroad among
patients suffering from diverse diseases and handicaps, showed that one third
to two thirds of the named group are having sexual problems. The physician
thus can expect that sometimes a patient is suffering from a disturbed love
life. What does the physician do about that? The position of sexuality within the medical
(anamneses) Physicians generally still seldom, if at all, ask
questions about the sexuality of their patients. This is the conclusion of a
number of investigations that were published since 1989. With respect to
that, unhappily, there is no news. A big majority of patients who were questioned would
like to talk about their sexual problems with the physician but feel that the
physician has to start the conversation about this subject. The physician
seldom, if ever, does so. Sex seemingly continues to be a difficult topic,
even for the modern physician. I have asked myself whether it would be of help to
include a pre-printed standardized questionnaire on the patient’s sexuality
in the medical files of the various medical specialties within a hospital. As
a pre-investigation I have requested a blank file from all departments of
this academic hospital. This pre-investigative action gave me access to the
files of thirty clinics and ambulant clinical services. The picture arising
this way on the first view supported my dark surmise: only in three files
have I found one or more pre-printed questions on the sexual functioning of a
patient. While having a further look at them I had to realize that there was
not one pre-printed anamnestical question mentioned in almost all of those files.
Thus, there also were no questions on sexuality. Introducing a pre-printed
questionnaire on the topic of sexuality of a patient in a medical file
therefore is not obvious. What then could we do about the unlikelyhood
of the physician to ask questions about the love life of his/her patients? Beside lack of time physicians when asked why they
don’t ask questions about the sexuality of their patients, sum up the fear
that patients might feel such questions are too personal and that the doctors
have too little knowledge and experience in this. Do we have to look for a
solution to this problem within the field of education and training? The
international literature within the past years describes a number of forms of
sexological education, within the education for
becoming a physician as well as within the education for becoming a medical
specialist. Students and registrars were very positive about those trainings.
Whether the trainings practically really had any effect on the physicians’
doings however has not been investigated. What about the sexological
education at Dutch Academic Medical Centres? Sexuality within the medical educational system "There is a remarkable imbalance existing
between the significance of the sexual life of a human being – and thus also
for the physician who has to treat this human being – and what one has
learned about it if one, armed with the medical degree leaves university and
starts to practice the ‘officium nobile’. "This was written in 1930 in the Dutch
Journal of Medicine, by Bernard Premsela, a general
practitioner and sexologist of Amsterdam who was killed in Auschwitz in 1944
(Premsela, 1930). In the meantime further events have happened. In
1971 the first Dutch university professor in the field of sexology has been
appointed. This was Coen van Emde
Boas who worked at the Has the sexual revolution come to an end? Is this
one of the many phenomenona of the complete
reformation of our society with the restoration of morals and values? Is
sexuality now an accepted part of medical education that does not need a
distinct chair anymore? The latter I dare to doubt. What kinds of
consequences will the disappearance of the chairs have for the sexological education in the long run? Let’s go back to
the situation in 1930 about which Bernard Premsela
wrote. Will the good sexological educational
programs that have been developed within the medical facilities during the
past years continue to exist? At the Sexuality within specialized medical educations The most important phase, as I always thought, with
respect to training sexological abilities for a
physician, are the routes to become a general practitioner or a medical
specialist. These the physician will be confronted with sexual problems of
patients for which the physicians are responsible. That’s why I organized the
polyclinic medical sexology in such a way that patient care training included
the service of the training of gynaecologists. Assisting physicians have an
obligatory practical training in sexology for a period of nine months. On
Wednesday afternoons, already the afternoon of the polyclinic of sexology,
assisting physicians meet all new patients under supervision of one of the
sexologists. At the end of the afternoon there are discussions about the new
patients among the professionals. The medical students learn to perform
simple medical actions under supervision. Our practical education is used to get
positive feedback from the medical students. Although we did not investigate
that, I think that this kind of education has sufficient impact. The students
have often told us that during their next practical education part of their
training they tend to ask questions about their patients’ sexual life with
much more routinely, with the result of being able to trace sexual problems
more often. They wish to have a sexologist on their side later on when they
work as gynaecologists. I am pleased that, thanks to our way of actively
engaging of the registrars within the care for patients at our polyclinic
sexology, now there are sexologists working in a many general hospitals. Some years ago it was possible to expand our program
within the two most relevant other medical specialties, urology and
psychiatry. Assisting physicians of those two areas got the chance to
contract comparable experience as did the assistants in the field of
gynaecology. Unhappily because of the financial cut back of some years ago
this program was discontinued. The practical work sexology for registrars
becoming an urologist no longer exists. The practical training within the
education to become a psychiatrist was maintained, fortunately. The last two subjects of my discourse are not about
the daily practical life of medical sexology but about the remarkable
relationship between the physician and love. Sexuality between the physician and the patient Recently in the journal ‘Medisch
Contact’ a verdict of a regional medical board was published about a
complaint of a woman against a physiotherapist (Crul
en Legemaate, 2003). She was under treatment at the
physiotherapist because of problems with her neck and shoulders. Beside that
she had marital problems. During the professional relationship romantic
feelings have developed between the physiotherapist and his patient which
have led to regular sexual contact between the two. Although the sexual contacts have taken
place with the consent of the female complainant, the
physiotherapist is said to have seduced her by sending sms-messages
to her and by calling her. She feels used by him as if she were a sexual tool
to play with which has been put aside as he had enough of the game. The
experience had severe ongoing consequences for her. Her marriage had come to
an end and a long lasting stay at a psychiatric hospital has been necessary.
She, as well as her children, are still being treated for mental problems
within the Mental Healthcare. The physiotherapist has another vision. According to
him the woman at a certain moment made clear to him that she was interested
in a more personal contact. He then did not react in a reluctant way but said
that the professional relationship should be stopped first and that it should
be nothing more than a one-night-stand. That sexual contact took place in a
hotel. The woman subsequently kept contacting him which led to further sexual
contacts between them, also in his office. Also the physiotherapist at a
certain point took her to his home. By doing so a friendship as well as
sexual relationship between him, his wife and the woman came into being.
After some months the complainant wanted the physiotherapist to chose between
herself and his wife. The physiotherapist chose to end the relationship with
his female ex-patient. According to him the woman stalked him for some time
by sending sms-messages to him. The medical board blamed the physiotherapist for
having harmed the physical integrity of his patient. That she agreed on the
sexual contact – or even initiated it – does not make a big difference. He
should have ended the professional contact immediately and if necessary he
should have transferred her to a colleague. He should have assured himself of
the fact that her wish to have sexual contact with him has developed independently
from their professional relationship and he should have insisted on a waiting
period during which they should not have seen each other. Because of the
seriousness of the accusation the medical board decided not to suffice with a
reprimand but to sentence the physiotherapist to a conditional suspension of
his professional registration for the duration of three months, with a
probation of two years. Physiotherapists
are not allowed to have sexual relationships with patients, just as
physicians are not allowed. This has been clear since Hippocrates.
Notwithstanding at times they do. Before 1989 it wasn't really known how
often it happens but numbers of up to 7% were given. Investigation
in recent years, however, talk about more or less 4% (life span). This
also is true for the Dutch investigation among gynaecologists and
throat-nose-ear specialists and very recent, not yet published, about
investigation among Dutch general practitioners. Most of them are older
physicians who are lonely and vulnerable or who are disappointed or angry at
their boss and who fall in love with a younger female patient. Besides that
group there are a small number of young physicians who frequently have sexual
relationships with female patients. Thus there are many "bunglers"
or "little scoundrels." During
my speech, 14 years ago, I already put question
marks behind terms like ‘power’, ‘abuse’, ‘offender’, and ‘victim’ in
the context of sexual relationships between physicians and patients. Such terms
do not reveal the complex reality, I stated then. Didn't you too think
when reading the story about the physiotherapist how far the ‘victim’ really
was a victim? Was she so powerless? Or was she more than anything else angry
because the physiotherapist finally chose to stay with his wife? Of course,
the physiotherapist shows more signs of a scoundrel than those of a
bungler, but finally he became also a victim of the revenge of his earlier
patient. In one of the charming University bookshops in Wertheimer is making a difference between morally
undignified sexual comportance, morally
unacceptable sexual comportance and juridically unacceptable comportance.
About morally undignified comportance he does not
say anything. Morally unacceptable comportance
(e.g. pretending to be in love to manage to persuade the other person to
engage into sexual contact) does not have to mean that this is a criminal
act. Therefore
also he prefers to not use the term ‘abuse’. Because this implicates that the
sexual activity is bad, wrong or illegal. The main question of Wertheimer is: when is it valid
morally or juridically to consent to sexual
contact? He wonders whether sexual contact without a complete, voluntary and
good informed consent of one of the partners by definition is morally or juridically unacceptable. If we would carry through with
respect to autonomy completely, then mentally deficient patients, women in
situations of economical pressure, or women who are mislead by a male, should
not be allowed to have sexual contacts. My
conclusion from this is this: when a female patient agrees on a sexual
relationship with a male doctor, then it still is questionable whether he,
from his position of power, is abusing her. Perhaps she also is abusing him.
To prevent misunderstandings from arising I once more stress that: physicians
also should not let themselves be abused by patients because this almost
always is bad for the patient. In this respect it is interesting that recently
articles have been published about patients who sexually assault
physicians (Phillips & Schneider, 1993). By the way, then we’re talking about
male patients and female physicians. Then we are talking about sexually
harassing comportance by men who are not in a
position of power. Perhaps especially because they are not in a position of
power and because they are having problems to be able to stand this, the
investigators wrote. My own conclusion would be it is a given fact that men,
male physicians as well as male patients, by nature tend to sexualize
contacts with attractive, fertile women. This has to do more with the nature
of species than it has to do with power. The sexuality of the physician himself About this I can speak briefly. I was not able to
find any literature written since 1989 about this topic. The stereotypical
picture from the seventies, the picture of the sexually reserved male with an
unfruitful marital life most certainly does not exist anymore. Today’s
physician without any doubt is different, if only for the bare fact that most
physicians nowadays are of female gender. Ladies and gentlemen, When preparing this article I searched the internet
to see whether there are stories to be found about the relationship of Asklepios, the god of healthcare, and Eros, the god of
sexual love. I did not find one. There seemingly did not exist a mythological
relationship between healthcare and sexuality. By this once more is proven
how remarkable it ever has been: the relationship between the physician and
love. Literature: Berlo, W. , van de
& Put, C. van der (2003). Jongeren met een lichamelijke handicap en seksualiteit. Een
overzicht van de literatuur. Tijdschrift
voor Seksuologie, 27, 114-124 Crul, B.V.M. & Legermaate,
J. (2003). Uitspraak tuchtcollege. Hulpverleners en
hun hormonen. Medisch Contact, 58, 1409-1410. Gamel, C.J. (2000). Sexual health care after cancer diagnosis:
development of a nursing intervention provided during the early recovery
period after treatment for gynaecological cancer. Thesis Universiteit Utrecht. Hengeveld. M.W. (1989). De medicus en de min. Oratie.
Rijksuniversiteit Utrecht. Knegtering, H. (2003). Antipsychotic treatment and sexual
functioning. Role of prolactin. Proefschrift Rijksuniversiteit
Nosek, M.A., Rintala, D.H., Young, M.E., Philips, S.P.
& Schneider, M.S. (1993). Sexual harassment of female doctors by patients. New England
Journal of Medicine, 329,
1936-1969. Premsela, B. (1930). Noodzakelijkheid van het onderwijs in de geslachtskunde aan de
toekomstige artsen. Nederlands
Tijdschrift voor Geneeskunde, 74, 2046-2049. Vroege, J.A. (1994). Vragenlijst voor het signaleren van
seksuele dysfuncties (VSD) (5e versie). Academisch
Ziekenhuis Utrecht/Nederlands Instituut voor Sociaal Sexuologisch
Onderzoek, Utrecht. Waldinger, M.D. (1997). When seconds count; selective serotonin
reuptake inhibitors and ejaculation. Proefschrift
Universiteit Wertheimer, A. (2003). Consent to sexual relations. Wilbers, D., Veenstra, G., Wiel, H.B.
van de & Weijmar Schultz,
W.C. (1992). Sexual contact in the doctor-patient
relationship in The Netherlands. British Medical
Journal, 304, 1531-1534. Vertaling: Redactie MdH, april 2004. Plaatsing: 13 mei 2004. |
[1] Tijdschrift voor Seksuologie (TvS) Jaargang 27, nr. 4, december 2003, ISSN: 0167-5915, pp 201-205.