Still an Unbreakable Taboo? Romance can be complicated for anyone. For physicians who may feel attracted to a patient or the patient's family member, the situation can be fraught with peril and could even endanger a doctor's medical license. Entering into a romantic liaison with a patient has been considered taboo since the time of Hippocrates. The attitude that it's never appropriate for a physician to become romantically involved with a patient remains strong but may be loosening some, according to Medscape's Physician Ethics Report 2016. Such relationships are always unethical and should be forbidden, according to an overwhelming majority (70%) of the 7500 physicians from more than 25 specialties who participated in our survey. That's down since 2010, when 83% felt that way. Only 2% of doctors say a relationship with a current patient is OK. Whereas 1 out of 4 male physicians believe that a relationship may be acceptable, fewer than 1 in 5 female doctors find it within ethical boundaries. Organized Medicine's Position The reasons for the prohibition are well known. Most respondents acknowledge the inherent power imbalance between doctors and patients, who may be vulnerable; have mental health issues; and see physicians during troubling times, such as illness or bereavement. Most respondents strongly endorse the position of the American Medical Association's (AMA's) Council on Ethical and Judicial Affairs[1]: Such interactions detract from the goals of the patient-physician relationship and may exploit the vulnerability of the patient, compromise the physician's ability to make objective judgements about the patient's health care, and ultimately be detrimental to the patient's well-being. At a minimum, a physician must terminate the patient-physician relationship before initiating a dating, romantic, or sexual relationship with a patient. The Federation of State Medical Boards has a model guidance for boards on how to address sexual boundaries with physicians[2]: We identify sexual impropriety as one type of professional misconduct described as behavior, gestures, or expressions that are seductive, sexually suggestive, disrespectful of patient privacy or sexually demeaning to a patient. One of the examples cited is "using the physician-patient relationship to solicit a date or romantic relationship." A Matter of Situational Context? Most doctors in our survey say the prohibition should be absolute. "Romance is not medicine," said a psychiatrist. "Having a romantic relationship is totally against the ethical standards of the profession. It's one of the best ways I know to lose one's medical license." For other physicians, the issue isn't as clear. It's wrong to have a relationship with a patient if you are managing controlled substances or dealing with psychiatric or other major medical issues, said a pain specialist. "But honestly, when you're seeing someone occasionally for a minor issue or procedure, then what is the big deal?" "A lot depends on the circumstances," said an otolaryngologist. "A primary care doctor who sees the patient regularly, no. But a specialist, emergency physician, or urgent care doctor who has one encounter with the patient and then will not likely see him or her regularly again—I don't think that's a problem." A plastic surgeon remarks, "I fell in love with a patient. We were both single, both physicians, and decided to marry after dating for 1 year. We've now been happily married for 26 years." A radiation oncologist tells of a colleague who ended up marrying a patient. "Both were widowed, and he transferred her care to a colleague before they started dating. They were together happily for two decades until he died of old age." "The heart wants what the heart wants," said a general surgeon. "Well-educated and informed adults can make their own decisions. But in a romantic relationship, the patient/physician relationship is probably irretrievably altered, and suitable provisions must be made for this." Changes in healthcare delivery and generational attitudes may account for the decline in the number of doctors who believe it's always wrong to get involved with a patient. "The patient/doctor relationship is a lot less formal than it used to be," said Tommy Bohannon, vice president of sale operations for AMN Healthcare, a Dallas-based physician recruitment firm. "It's more common for care to be episodic instead of a patient seeing the same doctor for years. Also, there's a generational difference. Young doctors aren't as formal. Many don't like to wear white lab coats. They may even encourage patients to call them by their first name. That lessening of formality may have an impact on this issue." Is a Waiting Period Acceptable? Does a delay make a relationship ethical? One in five doctors now say a romantic relationship is permissible—but only after a waiting period of 6-12 months, once the doctor/patient relationship has been terminated. Only 12% felt that way in 2010. "The right answer in this situation is, don't treat people you're sleeping with," said Kenneth W. Goodman, PhD, director of the Institute for Bioethics and Health Policy at University of Miami Miller School of Medicine. "Doctors must keep their personal lives separate from their professional lives. But after ending the doctor/patient relationship, a delay of 6-12 months seems like a reasonable solution, except maybe for psychiatrists, because the nature of the relationship is different." "Physicians really need to think through the consequences before starting a relationship with a patient, or even a former patient," Dr Goodman observed. "I'm not saying you need to be a prude, but think of how we can make sure the profession is never seen to be compromised by other considerations. There are real dangers. I know of doctors who've lost their licenses for prescribing antihistamines to lovers. Anticipate what could happen if the relationship ends badly and the other party is bitter. One phone call to the board of medicine can destroy a doctor's career. It usually just isn't worth it." Gerald B. Hickson, MD, senior vice president for quality, safety and risk prevention at Vanderbilt University School of Medicine in Nashville, Tennessee, said that physicians should be wary even with a 12-month delay before starting a relationship with a former patient. "I'm not rigid, but doctors should at least pause and reflect on the implications of how the relationship could affect colleagues and other patients," he said. "Never say never, but starting a relationship with a former patient requires some serious thought." But there's a diversity of opinion on the subject. An occupational medicine doctor said, "Actually, I don't think there has to be a waiting period. There's nothing wrong in starting a relationship immediately after terminating the doctor/patient relationship." An internist added, "It's always best to avoid going out with current patients. But when they are no longer a patient of yours, it isn't anyone else's business what consenting adults do." What About a Patient's Relative? Is dating a patient's family member acceptable? Seventy percent of doctors in our survey believe that having a romantic relationship with a patient's family members is unethical. That's the same percentage of doctors who say it's never appropriate to have a relationship with a patient. Still, 19% say a liaison may be fine, depending on the circumstances. Only 10% say that such relationships aren't an ethical problem. Most of the doctors who say that "it depends" cite the type of physician relationship, plus location and community size, as factors that must be considered. That's in line with what the AMA says in urging physicians to tread carefully with such relationships[1]: "Patients are often accompanied by third parties who play an integral role in the patient-physician relationship," such as spouses or partners, parents, guardians, or surrogates. "Sexual or romantic interactions between physicians and third parties...may detract from the goals of the patient-physician relationship, exploit the vulnerability of the third party, compromise the physician's ability to make objective judgments about the patient's care, and ultimately be detrimental to the patient's well-being." Dr Hickson of Vanderbilt agrees. "I'm a pediatrician," he said. "Starting a relationship with a patient's relative is dangerous. Children have parents, often single parents. The need to maintain boundaries is important." Most would probably doctors agree, but some cite exceptions. "It's easy to make statements about the ethics of such things," said a psychiatrist. "But if you're taking care of Grandpa and his granddaughter brings him to office visits, chemistry may happen. It's impossible to legislate such things, the same as it is impossible to legislate workplace relationships." A family physician said, "It's entirely dependent upon the nature of the patient's treatment. Yearly well-visits? One episode of poison ivy? That's not a problem. But ongoing treatment for major illness or psychiatric illness? That's a problem." Relaxed Rules for Rural Doctors? Where a physician practices also makes a big difference. As one family physician succinctly put it, "I live in a community of 2000 people, and 1500 are patients. What else is left—the priesthood?" A general surgeon said, "Have you ever worked in a small town? I meet every patient I care for at Wal-Mart, whether I want to or not." Another family doctor added, "I work in a rural community with only two doctors. I have treated essentially every person in my region at one point or another. While I am happily married, we do occasionally have unmarried providers in our area. I think it is not unreasonable for them to become involved with individuals who may have been seen for a minor injury or cold at some point in the past. It is difficult to set defined parameters, and that applies to family members of patients as well." A critical care physician agreed. Dating a patient's relative "is probably not a good idea," he said, "but there are circumstances where that wouldn't be horrible. Think of a divorced dad who brings his child to an urgent care office with a cold. Then you meet up again at a Little League game several months later." Still, most physicians say that dating a patient's relative is always wrong. "It's a big world," said an orthopedist. "A treating provider should look elsewhere for emotional and physical involvement." Dr Goodman, the bioethicist, sympathizes with physicians in small towns but agrees that they should maintain boundaries. "In a small town, everyone knows everyone," he observed. "If anything goes wrong in the relationship, it could be damaging to the patient—and the doctor. It's best to find another town nearby to meet people. It's not about judging people, but maintaining professionalism and erring on the side of caution." Tommy Bohannon, the physician recruiter, noted that single small-town physicians face a difficult problem. "It's hard to date when the other person knows all about your social standing, income, etc, before you've even had dinner," he pointed out. The issue of dating often comes up when Bohannon is trying to recruit a doctor to a small town. "It's an important consideration," he reflected. "Often, the doctor has put his or her social life on hold while completing training. They are now eager to find a mate and want to know about the singles scene. "It's easy to say that there are other fish in the sea, and a doctor should have little trouble finding someone to go out with," Bohannon said. "But you can't account for who you fall in love with." Source
