Are More Physicians Saying It's Okay to Date a Patient? Physician-patient romance has long been considered taboo, but physicians are increasingly questioning exactly where the dogmatic line in the sand lies. Since 2010, the percentage of doctors who say it is or might be acceptable to become romantically or sexually involved with a patient or with someone who had been a patient as recently as 6 months earlier, has increased greatly, according to Medscape's Ethics Report 2018: Money, Romance, and Patients. Two percent of the 5200 physician respondents said it would be acceptable to date a current patient, and 25% greenlighted dating someone who had been a patient as recently as 6 months earlier. That's up from 1% and 12%, respectively, in 2010. The percentage of physicians who say the acceptability of dating a patient would depend on the situation (10%) has likewise doubled over the past 8 years. "Sexual exploitation is not ethical, but romance does happen," noted one physician. Others weighed in with such comments as "two consenting adults should be able to have a romantic relationship," "as long as both welcome it," and "as long as it is reciprocal and/or consensual and outside the office setting." In focusing on consent, a number of physicians objected to the notion that an imbalance of power between the two parties—an often-cited argument against doctor-patient romances—constitutes a barrier. "In spite of what ethicists have to say on the topic, a competent adult is either that or not," wrote one. "You can't say they are competent in one aspect of their life but not another, as that is a very paternalistic view and that is not ethical either. Clearly as a physician, you have special access to your patient, but does that by definition make a relationship unethical? Just because there has been bad behavior in the past by some, you cannot regulate human behavior and feelings like this." Others suggested that the power imbalance isn't as significant as it once was and that doctors should not be held to a higher standard than other professionals when it comes to romance. "I don't think physicians have the clout they once had. Often they are seen as just another worker now. In other words, the physician isn't seen as having authority over his/her patients," wrote one physician. Another noted, "We are all human. Many relationships start at work in other fields, so why not the medical field?" In supporting their responses, physicians expressed views that reflect shifting societal dynamics, including the #MeToo movement and the perception of physicians' roles in society. The result was a general sense that relationships are ill-suited to one-size-fits-all ethical solutions. Emphasis Placed on Consent and Intent The debate over the ethics and professionalism of physician-patient romance is far-ranging and complex, and age and gender appear to be important factors in determining individuals' views. Male physicians are far more likely than female doctors to say that dating a current or former patient is or might be acceptable (40% vs 28%). Older physicians—who are more likely to be male—likewise showed greater openness to the idea of dating a former patient. Midcareer doctors (between the ages of 40 and 54 years) were the least likely to condone doctor-patient romance, whereas older doctors were the most likely to accept the practice. Roughly 3 out of 10 survey respondents older than 65 years said dating a current or former patient was acceptable. Are female physicians more attuned to the #MeToo movement and more sensitized to power imbalances in relationships? Are older doctors more open to dating former patients because they may not have seen those patients in a clinical setting for decades, or do their responses reflect a generational difference? Although it's impossible to draw specific conclusions, many physicians' comments seem to reflect trends playing out in society as a whole. For many years, respondents to the Medscape ethics surveys cited the lack of potential romantic contacts in rural practice settings, an extended period between treatment and an eventual romance, and episodic care (such as a trip to the emergency department for a broken arm) as reasons why romance with a patient might be acceptable in some circumstances. Those arguments are still the most prominently cited in the 2018 results, but they're accompanied by numerous comments that focus more on the would-be romantic partner's consent. A number of respondents felt that because becoming romantically involved with a patient is a serious matter, consent is not enough. They qualified their answers by noting physicians should be single; relationships should not be based solely on sexual attraction; and, as one wrote, "the intent is courting with the hope or expectation of marriage." Ethicists and Lawyers Weigh In Ethics are important, but so is the specter of being reported and called before a medical disciplinary board. For most physicians, that threat trumps any issues of romance or ethical boundaries. Arthur Caplan, PhD, head of the Division of Medical Ethics at NYU School of Medicine, suggests that the emphasis on consent and intent in this year's responses may be a reaction to events playing out on the national stage. The past 2 years have been dominated by the #MeToo movement, the Brett Kavanaugh hearings, the Access Hollywood tape featuring President Donald Trump, high-profile celebrity controversies, and sex abuse scandals surrounding team doctors for USA Gymnastics and Ohio State. In focusing on consent and intent, respondents are probably trying to clarify their positions and differentiate the scenarios they are describing from the controversies being played out in the headlines. "Their focus is on sincere and legitimate relationships," Caplan says. "They want to make it clear that it's not acceptable to take advantage of someone, so they're saying, 'If your intent is noble and pure, you're probably okay.'" But the matter is not that simple, he says. Not by a long shot. "Sex and romance is probably one of the most complicated areas of moral life for doctors—and everyone else, for that matter," Caplan says. "I think we are more willing to talk about this than we were before." Relationships Vary on a Case-by-Case Basis Consent is a mandatory baseline for any romantic relationship, and intent is a hard thing to gauge, particularly at the outset of a relationship. It's unrealistic to assume that a single doctor—or anyone else venturing out on a first date—has marriage on their minds. "For me, the issue is professionalism," Caplan says. "I see boundaries as set by professional ethics." Doctors shouldn't look for a single, cut-and-dried answer on the topic. Different standards may apply to the oncologist who treated a patient's cancer and the podiatrist who removed their bunion. As for whether a particular relationship is acceptable after 6 months or 6 years, the question is open to debate. And that's a good thing, even if there's disagreement, because it challenges doctors to explore different facets of the question, insists Ken Goodman, PhD, co-director of ethics programs at the University of Miami. "We are playing with hypotheticals, and that is a good idea, but the facts always matter and they will shape the right answer. This is an ancient profession," he says, and whereas some survey respondents may suggest that medicine is no different from other professions, Goodman maintains that it is. I would not fault someone who, after an appropriate length of time, wanted to have a relationship with a former patient—but the tricky part is, what is an appropriate length of time? "Being a physician is different from being a gardener or a greengrocer," says Goodman. "I'm sorry if you feel disrespected. I'm sorry if you feel there has been an erosion in your status or prestige. I'm sorry if you don't like being an employee, but the standards of professionalism haven't shifted. I would not fault someone who, after an appropriate length of time, wanted to have a relationship with a former patient—but the tricky part is, what is an appropriate length of time?" Standards of professionalism are equally important from a lawyer's point of view. "There are two sides to every story, and different people will have different perceptions," says Bruce Vande Vusse, a Detroit attorney specializing in healthcare litigation. "What sounds reasonable to one person will make another person ask, 'What were you thinking?'" Physicians need to bear in mind that a soured relationship with a patient could result in a legal case or a medical board disciplinary proceeding, and although the physician might prevail, patients and members of the public may take a dim view of the doctor's professionalism. "A lot of things are legal, but that doesn't make them a good idea," notes Steven Babitsky, a lawyer and president of SEAK Inc., a physician training program. "I think the 64% who said 'no' to dating a patient got it right, frankly. I understand where the others are coming from: Consenting adults shouldn't be denied the opportunity for a relationship, but I think when you're talking about doctors and patients, the scenario is rife with problems." 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