Is Physician/Patient Sex Still Taboo? Medscape's 2014 Ethics Survey, in which more than 21,000 physicians took part, found that having intimate relations with a patient, although still taboo to most respondents, is no longer as unthinkable as it once was to a significant number of doctors. Read Also: What Kind Of Doctors Do Patients Prefer "Professionalism should not mean that every aspect of one's personal life is policed by the profession," a doctor wrote, one of hundreds who proffered comments pro and con. "My main objection to relationships between doctors and current patients is that medical practice should not be coopted for speed-dating during office visits, as that harms the integrity of the profession. But if doctor and patient have occasion to meet outside the confines of the clinic and there's no ongoing therapeutic relationship, it's none of my business what they do." To be sure, the majority of commenters were dead-set against a doctor dating a current patient, and many objected to a physician having intimate relations with a former patient as well, regardless of how much time may have elapsed. "It's unethical and immoral to get involved with a patient," one doctor flatly stated. "Never, never, never, never!" wrote another, an oft-echoed sentiment. "Once a patient/doctor relationship is established, it will always be a patient/doctor relationship," a third physician insisted. "Even if the romance starts a long time after the doctor/patient relationship ends, the asymmetry in the doctor/patient status will bear poisoned fruit," a physician warned. "There should be no gray areas here," another doctor declared. "No is no." A Significant Change in Attitudes Nevertheless, our latest ethics survey revealed that this traditional taboo, although still embraced by most physicians, has an increasing number of exceptions. The survey found that 68% of the respondents felt that an intimate relationship with a patient, whether current or former, was unequivocally unethical and wrong. Medscape's 2010 ethics survey, in which 83% of the respondents took that position.[2] Still, it's clear that physicians are typically against becoming involved with a current patient. In both our 2014 survey and our 2010 survey, only 1% of the respondents felt it was permissible to have sex with a current patient. "Consenting adults may do what they please," a doctor wrote in a representative comment. "If both of us were single and were attracted to each other, I don't see any reason why this would be unethical," another doctor observed. "I think it might be awkward or uncomfortable," he conceded, "but not unethical." More significant is the change in the number of physicians who believe it's not ethically problematic to date a former patient after a period of time has elapsed. In our 2014 and 2010 surveys, we suggested 6 months as a possible waiting period before becoming romantically involved. In 2014, over one fifth (22%) of the survey respondents asserted that this was ethically permissible. In our 2010 ethics survey, only 12% of participating doctors agreed with that time restriction. "If a doctor and patient do fall in love, the only correct way to solve the dilemma is to end the doctor/patient relationship," a physician wrote in a comment typical of doctors who subscribed to this view. "Then possibly start your romantic relationship—if it is mutual—but only after the patient has established care with somebody else in your specialty." "Once they are no longer your patient, I do not see why it is unethical," another doctor commented. "Not for me, but wouldn't think it wrong if someone else did it," a doctor believed, adding, "Never for a current patient." In 2014, 10% of respondents felt that whether it was ethically permissible for a doctor to have intimate relations with a patient had to be judged on a case-by-case basis, rather than condemning the practice across the board. This was a significant increase since our 2010 survey, where only 5% of participating physicians felt likewise. Among the 2014 commenters, in contrast to the shrinking majority of physicians who insist that a doctor should always be in control of his or her emotions, was a frequently expressed belief that even for doctors, love can sometimes be blind. "You cannot fight sexual chemistry and attraction, so if there was a potentially genuine possible romance, then the doctor should transfer care to someone else and thus void his doctor/patient relationship," a doctor wrote. "I wouldn't do it, but it has happened with a colleague," another doctor admitted. "Maybe I shouldn't state this, but we are only human." "We're all human," another physician concurred. "As long as the unequal power equation is over or markedly reduced, there's no reason two people should be prohibited or even discouraged from seeking happiness together." "This can be tricky," a doctor confessed, "but love, true love—why not?" Organized Medicine's Position The American Medical Association's (AMA's) position on the subject, formulated in 1990 and since adopted by many specialty societies and state medical licensing boards, hasn't wavered in the past 24 years: A physician should never have sexual relations with a current patient. "Sexual contact that occurs concurrent with the patient-physician relationship constitutes sexual misconduct," the AMA unequivocally states in an official opinion. "Sexual or romantic interactions between physicians and patients detract from the goals of the physician-patient relationship, may exploit the vulnerability of the patient, may obscure the physician's objective judgment concerning the patient's health care, and ultimately may be detrimental to the patient's well-being." Even dating a former patient "may" be problematic, the AMA contends, regardless of how much time may have elapsed. "Sexual or romantic relationships between a physician and a former patient may be unduly influenced by the previous physician-patient relationship," the AMA elaborates in its official opinion. "Sexual or romantic relationships with former patients are unethical if the physician uses or exploits the trust, knowledge, emotions, or influence derived from the previous professional relationship." This rationale is predicated on the notion of unequal power relations: The doctor, in his or her capacity as a physician, wields such psychic power over the patient that, "according to some, patient consent is not possible," notes attorney Tanya J. Dobash, JD, in the Washington and Lee Law Review. Dobash continues: "The medical profession has concluded that the risk of coercion is so high that true and authentic consent on the part of the patient in this type of relationship is usually lacking. The disproportionate distribution of power within the physician-patient relationship deprives the patient of the ability to give meaningful consent to a sexual relationship with the physician." "Despite the medical profession's attempt to promote patient autonomy and eliminate medical paternalism," Dobash adds, "society continues to accord high status to physicians as the omnipotent interpreters of medical truth and knowledge, and individual patients often unquestionably submit to a physician's authority." Are Patients Capable of Consensual Relations? Regardless of where they stand on the issue of doctor/patient romance, many doctors would find this rationale—that in 2014, doctors are still regarded as being in a situation of unequal power over patients—archaic, paternalistic, demeaning to patients, and grossly at odds with current reality. Their reasoning: If patients so often unquestionably submit to a physician's authority, why do so many fail to comply with their doctor's instructions? Why do so many switch doctors if their doctor drops out of their health plan, fails to prescribe the drugs they want, badgers them about changing their unhealthy lifestyles, or for any number of other reasons? "The balance of power no longer resides with physicians," one doctor ruefully noted in our latest survey. Fifty Shades of Grey Morality aside, many commenters pointed out practical—and impractical—aspects of having intimate relations with a patient. "You risk losing both your clinical objectivity and your license," a doctor warned. "This has trouble written all over it, even if you wait 2 years," commented another doctor. "The patient is going to think he or she has special privileges with the doctor—like free dope, pills, etc.—so it's not just about having sex. You're gonna pay and pay and pay." Many psychiatrists wrote that for them, having intimate relations with a patient, even a former patient, was not only morally objectionable but illegal in their states. Many pediatricians noted that for them, sex with a patient was a criminal offense. But what about doctors whose situational context limits their choice of partners? "I live in a small town," one doctor explained. "It would be hard to have friendships if I didn't become friends with my patients, and if I were an unmarried FP, I think the odds of finding a spouse would be about the same." "Anyone who is coming in in a vulnerable position and trusting the doctor as a counselor prior to the relationship should not be pursued romantically," this doctor added. "But the guy who sees you for a physical and has lots of common interests and is single in your small town seems fair game, if he understands he can no longer be your patient." And what about the many physicians who serve as doctors to their spouses? "My husband was my patient until I left that practice," a doctor confessed. "I have always been a physician to my fiancé/spouse," another doctor wrote defiantly. "I don't see the objection." Several commenters objected to being held to rigid ethical standards that other professionals aren't. "Why should a HUMAN be refused the opportunity to meet and love someone, so long as it isn't taking advantage of a vulnerable person (psychiatry)?" a doctor protested. "Why must a physician be forced to avoid what every other professional is allowed to freely do?" "Life is short, and as long as you aren't a pediatrician, I don't see the problem with CONSENTING adults exploring their romantic feelings in an appropriate setting," another doctor argued. As for romance with a patient being the road to ruin, there were also dissenting views. "I married a patient, and that was forty-five years ago!" one doctor observed. "One of the happiest marriages I have seen was the result of such a relationship," another doctor wrote. "Yes, it's risky, but blanket rules ignore the complexity of human interactions." There were also numerous pleas for understanding. It's hard enough for an overworked doctor to find a significant other these days, these commenters contended, even when patients are considered among the prospective candidates. "It's a terribly small world out there for single people," a doctor observed. "I know. I'm one of them." Most doctors who offered comments, though, viewed this as a lame excuse. "Go hunting somewhere else, and don't blur lines," one scolded. "Try Match.com." References Kane L. Medscape ethics report 2014, part 2: money, romance, and patients. Medscape Ethics Center. December 22, 2014. http://www.medscape.com/features/slideshow/public/ethics2014-part2 Accessed December 26, 2014. Cerrato P. Exclusive ethics survey: is it ever okay to date a patient? Medscape Medical Ethics. December 14, 2010.http://www.medscape.com/viewarticle/732786 Accessed November 17, 2014. Sexual misconduct in the practice of medicine. Council on Ethical and Judicial Affairs, American Medical Association. JAMA. 1991;266:2741-2745. Dobash TJ. Physician-patient sexual contact: the battle between the state and the medical profession. Wash Lee Law Rev. 1993;50:1725-1759. Source
