HONOLULU – The stalking of physicians by patients is a real phenomenon, and physicians have not been trained how to handle it, a Canadian survey suggests.

Stalkers who target physicians are more likely to be females stalking males, the study found, while just the opposite is true for stalkers and their victims in the general population.

Stalking is defined as repeated acts that are experienced by the victim as intrusive, creating apprehension in the victim, and which can be understood by a reasonable fellow citizen to be grounds for becoming fearful, Dr. Gail E. Robinson said at the annual meeting of the American Psychiatric Association.

In the general Canadian population, 4%-9% of males and 9%-13% of females have been stalked, previous studies report. In total, 80% of offenders are male, and 75% of victims are female.

Dr. Robinson and her associates surveyed 3,159 physicians in Toronto, 37% of whom responded. They found that 177 (15%) of the 1,191 respondents had been stalked, including 11% of male respondents and 14% of female respondents, said Dr. Robinson, professor of psychiatry and obstetrics/gynecology at the University of Toronto.

The findings are consistent with previous reports suggesting that 6%-13% of health care workers have been stalked, said Dr. Robinson, who also is director of the university’s Program in Women’s Mental Health.

In the current survey, psychiatrists were the most likely to report being stalked, followed by ob.gyns., and then surgeons. Stalking was reported by 26% of psychiatrists, 16% of ob.gyns., and 16% of surgeons. Among solo practitioners, 15% reported being stalked, as did 8% of respondents in group practices.

The stalkers were patients in 67% of cases and ex-patients in 20%, with relatives, partners, or others making up the rest of the stalkers.

The toll on physician victims of stalking can be severe, yet 90% of survey respondents said they had received no education about identifying or managing stalking by patients before they were stalked.

Among physicians who had been stalked, 23% felt very or extremely embarrassed by it, which might be a factor that inhibits physicians from identifying and dealing with stalking, Dr. Robinson said. About 9% said the stalking made them very or extremely depressed, 45% felt very angry about it, and 5% said they felt very or extremely guilty.

Half of the victims said they were very or extremely frustrated by the stalking, 46% were very or extremely anxious, 40% were very or extremely frightened, 36% felt very or extremely out of control of the situation, 25% felt very or extremely helpless, and 7% felt hopeless.

Stalking also can lead to financial losses and loss of friends and freedom for the victim, she said.

Victims of stalking reported threatening behavior by the stalker in 11% of cases, vandalism in 2%, and physical harm in less than 1% of cases. Male physicians were more likely than females to report threats or harassment of family or friends by the stalkers. Male physicians were more likely than females to say that their stalkers were motivated by anger about their care, or because they were upset about an outcome.

Delusion motivated many of the stalkers, respondents said. Among physicians who said they had been stalked, 42% of women and 38% of men said the stalker was delusional.

Physicians – especially psychiatrists might have difficulty at first identifying a patient as a stalker rather than someone who is experiencing transference or some other problem that can be discussed and resolved relatively easily, Dr. Robinson said.

Victims in the survey reported warning signs of stalkers, which differed by sex. Half of male stalkers were described as "very demanding," 34% were said to be "easily angered," and 31% were described as delusional. For female stalkers, 49% were described as "very dependent," 31% showed interest in the physician’s personal life, and 28% professed love for the victim, respondents said.

Physicians can take precautions against stalking by setting clear boundaries with patients, including giving them an information sheet describing limits, Dr. Robinson said. Avoid listing private information in publicly accessible sites, and be careful what you leave out in your office or clinic, she added.

If you suspect a patient is showing prestalking or stalking behavior, restate clear boundaries in the physician-patient relationship. Clarify to the patient that there is no chance for any other kind of relationship. Consider reassessing the patient’s diagnosis, Dr. Robinson said.

Alert police about the problem early, and start recording calls and keeping any communications, she advised. Alert office staff, family, and friends about the problem. If the stalking persists, terminate your services to the patient, and do not initiate contact with the patient after the termination or respond to the patient’s attempts at contact.

Dr. Robinson said she has no relevant conflicts of interest.

Physicians Need Training on Handling Stalkers