On Cleavage

It is almost inevitable that a physician will experience, over a long career, sexual arousal while seeing a patient.

In the vast majority of cases the feelings are rare, brief, without any violation of decency standards.

Many of us learned in our training that we might experience occasional erotic sensations  in the course of our clinical work.  We were assured that it was not abnormal to do so, though we were told we must never  act out any of those feelings.   To Wit, fleeting feelings were normal, prolonged feelings were a call for going on red alert.

Episodes of arousal are  usually biological, without emotional baggage, but they could indicate, presenting as a flirtation or seduction, a significant personality or psychological disorder.  

When the experience is anything more than ephemeral it becomes crucial to determine whether it is the doctor or patient launching Cupid's arrow.   In either case problems may go way beyond the exam room, permeating important relationships.  Psychiatric consultation can be of great benefit in sorting things out.

About twenty years into my practice I felt confident that sexual arousal in the exam room was not one of my problems.

But that changed one day when a new patient with a cough was brought into my office.  

Not only was she curvaceous but she had a full bosom with an an arresting cleavage.  Inchoate feelings of arousal started almost immediately and I found myself in a battle to not look at her chest, hoping my eyes would lock instead on to her eyes,  suggesting sincerity and caring rather than the embarrassing and over heated feelings I was struggling against.

Alas, my defenses crumbled when I examined her.

It was my habit to tell  patients what I was doing as I examined them: now I'm going to look at your throat, now I'm going to listen to your lungs.  Disaster struck when I came to listen to this patient's heart when I heard myself say, quite clearly and audibly - and now I'm going to listen to your breasts.

She gave no signal that she heard me though I felt certain she had.  Since she said nothing I decided not to open a can of worms and,  feeling exposed  and mortified, said nothing.

For the next twenty-two years, when coming to a  heart exam 
I would faithfully say, "and now I'm going to listen to your (pause, pause, pause, get it right) heart.

What did I learn?

I learned that  I was human and not always as in command of my feelings as I had imagined.  Moreover, I learned that patients can be generous in forgiving our frailties.  

Whatever feelings of attraction  I had for the patient were extinguished by the experience and our doctor patient relationship took an ordinary trajectory.