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Study spotlights prevalence of inappropriate patient behavior in the urology clinic


A study presented during the 2022 Society of Women in Urology Annual Clinical Mentoring Conference highlighted patterns of inappropriate patient behavior in an outpatient urologic clinic setting.1

Maxim McKibben, MD

Maxim McKibben, MD

“I came to realize that there wasn't really a great mechanism for addressing these inappropriate interactions,” Maxim McKibben, MD, an author on the study, said when explaining the background of the research. “And because of power dynamics, maybe someone who’s a medical assistant or front desk staff is not comfortable coming straight up to a physician to talk about one of these interactions. So, we really wanted to define the scope of the problem,” added McKibben, a urologist at Atrium Health in North Carolina.

Caroline Lu, MD

Caroline Lu, MD

“Inappropriate patient interactions are more prevalent than we know, and they're oftentimes underreported,” added another author on the study, Caroline Lu, MD, a resident at Atrium Health.

After gaining approval from the Institutional Review Boards (IRB), McKibben, Lu, and co-authors distributed surveys to 103 staff members within the department of urology at a single institution. Exclusion criteria included employees who did not interact with patients and those who only worked in an inpatient setting.

The Survey Monkey questionnaire aimed to gather data on the staff’s demographics and experiences with inappropriate patient interactions using multiple choice and open-ended questions.

Statistical analysis was conducted using SAS software version 9.4 and Fisher’s exact test, comparing the responses of staff members among different demographic subgroups.

Overall 69.6% (71/103) of employees responded to the survey, including 21 physicians (29.6%), 18 nurses (25.3%), 8 medical assistants (11.3%), 7 nurse practitioners or physicians assistants (9.9%), and 17 other employees (23.9%).

Of this population, 83.1% experienced verbal abuse by patients, 74.6% witnessed abusive interactions toward others, 59.2% experienced sexual harassment, and 14.1% experienced racial or ethnic abuse. However, 66.7% of employees did not report an abusive interaction, with the most common reasons selected being “it was not a big deal” (35.2%) or “damaging the patient-provider relationship” (15.5%).

Additionally, Lu revealed that there were no differences in experience between physicians versus non-physicians. “What was [also] really surprising to us,” said Lu, “was that when we looked at differences between gender and who was experiencing different kinds of inappropriate behavior, we found that female employees were just as likely to experience this as male employees.”

Another important finding was that non-White employees were more likely to encounter discrimination based on race or ethnicity and less likely to encounter sexual harassment when compared to white employees (P <.05).

“I think our next steps of this project would not only be to develop some kind of mitigation [strategy] or policy for when this occurs,” concluded Lu, “but also collaborate with other institutions, other practices…I think there's going to be a lot of interesting conversation and discussion that comes out of this project.”


1. Lu C, Kearns J, Robinson M, et al. Determining the prevalence of inappropriate patient behavior in the outpatient urology clinic. Paper presented at: 2022 Society of Women in Urology Annual Clinical Mentoring Conference; February 7-9, 2022; New Orleans, Louisiana. Poster 6127.

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