As usual, I performed the examination with my female medical assistant I also warn them that if their doctor-patient relationship included. There is no such thing as a consensual sexual relationship between a doctor and a patient, but sometimes, in certain contexts, considering certain factors, things. Can I date this woman now? Answer: It would not be . These doubts may interfere with the doctor-patient relationship and could lead a patient to withhold.
Sexualization of the doctor—patient relationship: Family Practice ; Introduction All codes of ethics set up by medical professional bodies prohibit sexual relationships between a doctor and a current patient. Although this stance initially provoked a degree of controversy within the country, 2— 6 the deleterious effects of such relationships upon patients have become increasingly recognized and condemned by the medical community.
However, some areas of debate do still remain. One such area is whether sexual relationships with former patients are ever ethically permissible and, if so, under what circumstances. First, the concepts of boundaries and transference are discussed and a profile of the medical practitioner at risk of offending is drawn.
Secondly, three aspects of the doctor—patient relationship are explored: Thirdly, a discussion of the role of autonomous choice and consent is presented. Boundaries and boundary violations Many boundaries exist in the doctor—patient relationship.
The Seductive Patient
These include boundaries of role, time, place and space, money, gifts and services, clothing, language and physical contact. This does not mean that no such type of relationship may exist, but it has not been researched.
This suggests that the overwhelming outcome for most, if not all, patients is negative. However, the crossing of boundaries per se does not necessarily mean that an unethical act occurred: Nor do all boundary transgressions between doctor and patient ultimately lead to sexual misconduct. Clues as to what these other factors should be can be gleaned from examining the profiles of offending doctors. Profiles of doctors who violate boundaries A key factor in the identification of doctors at risk of violating boundaries is the enhanced vulnerability of a doctor to the transference—counter-transference dyad which occurs in varying degrees in every doctor—patient relationship.
Doctors can mistake the feelings of love that arise in a therapeutic relationship as being the same as love that arises elsewhere; it is not. Transferences per se, as with boundary crossings, also occur in normal love relationships, 12 and therefore are also a necessary but not sufficient condition for ethical unacceptability. However, it is the existence and persistence of this type of transference, linked with the fiduciary relationship and unequal power structure, which makes most relationships with former patients ethically unacceptable see following sections.
In turn, to build such a relationship, the unequal power distribution between doctor and patient has to be acknowledged and contained in an ethically correct manner.
The Seductive Patient - Curbside Consultation - American Family Physician
The onus of responsibility for this last task falls on the person who has the most power in the relationship which, as I will argue, is always the doctor. To explain why this is always the case, even with former patients, it is useful to consider the sources of medical power in light of a framework suggested by family practitioner and ethicist, Howard Brody. In his book The Healer's Power, 20 Brody outlines three sources of medical power: Aesculapian, Charismatic and Social. It has also been suggested that another source of power —Hierarchical power, the power inherent by one's position in a medical hierarchy e.
Although it does not involve the sexualization of the doctor—patient relationship, it clearly illustrates the importance of recognizing all four types of power, and, in particular, the prominence of Hierarchical power: A consultant specialist was admitted to hospital with a severe multi-system disease causing severe renal impairment.
After 6 weeks in hospital, on the day of his planned discharge, he was accidentally given another patient's medication. Instead of receiving his azathioprine and corticosteroids, he was given a high dose of frusemide and captopril.
Simply by the sheer nature of taking on the role of patient, regardless of any other type of power, there is always an unequal power differential between the doctor and patient. This applies in both general practice and hospital-based medicine, although it may be accentuated by the latter's institutional culture.
However, there is also the question of whether this type of power would be accentuated further in a fee-for-service situation, as exists in general practice in Australasia, as opposed to free public hospital treatment.
This differential is exacerbated further by any imbalances arising from the other three sources of power.Department of Psychiatry Video - Brigham and Women's Hospital
Furthermore, many physicians recall little specific training about the appropriate boundaries to maintain with patients. In Maryland, all new physician licensees attend an orientation session that focuses on boundary issues. It seems apparent that many of these new doctors feel that they have not previously been provided with information on how to successfully navigate these uncharted waters.
The preclusion against becoming socially intimate with patients stems from two basic assumptions. The first is that the physician holds the greater power in the doctor-patient relationship by virtue of his or her training and position. Because of this disparity, patients might be exploited by their physicians. The onus, therefore, remains with the physician to act always in the patient's best interest. The second assumption is that when a dual relationship exists with a patient such as being both physician and loverobjectivity is lost.
As a result, subsequent treatment may be compromised. In addition, a large body of literature suggests that when physicians become intimate with their patients, the patients often suffer significant and lasting emotional harm.
The code of ethics of the American Psychiatric Association instructs psychiatrists that the doctor-patient relationship is an enduring one, which precludes them from pursuing a personal, social or sexual relationship even if the patient is no longer under their care.
Because patients may need to return for further therapy, personal involvement remains inadvisable. The codes of the American Medical Association and the American Osteopathic Association warn physicians of their duty to act in their patients' best interests and not to exploit the doctor-patient relationship.
Beginning a personal relationship with a key third party might jeopardize the care of the patient.
Doctor-Patient Relationship in Psychiatry
When instructing new licensees in the orientation sessions, I encourage them to terminate their doctor-patient relationship before pursuing a social relationship with a patient. I also warn them that if their doctor-patient relationship included counseling or intimate examination of the patient, or if it was a long-term association, the risk remains that a subsequent personal relationship may be considered patient exploitation. Physicians often do not realize the enduring nature of the doctor-patient relationship and do not appreciate that the transference phenomenon is not limited to psychiatric care.
Even a brief association with the physician can significantly affect the patient. In these orientation sessions, someone always asks about the rural physician who has everyone in town for a patient.
In nine years serving on the Maryland Board of Physician Quality Assurance, that scenario never presented to me. The typical physician who is disciplined for having sex with patients is married and has been involved with multiple patients. The patient most often makes complaints about physical impropriety after the sexual relationship has ended or when a subsequent treating therapist supports the patient in making a complaint. Often, the complaints come from the patient's spouse or even the physician's spouse.
Licensing boards look at every complaint regarding physician impropriety and adjudicate it on the individual merits of the case. The physician in this case scenario acted swiftly and appropriately to avoid becoming entangled in an inappropriate relationship.
However, physicians must realize that, especially when they are personally stressed, they are vulnerable to becoming involved with their patients.
Many physicians who are disciplined for unprofessional conduct with patients become involved when they are in the midst of a divorce, are stressed by overwork, have a family member who is ill or have recently suffered a significant loss. During such times, a compassionate patient may end up hearing a lot about a doctor's troubles rather than having his or her own health needs addressed.
Physicians should realize that they can and should seek support and help from their colleagues when their personal troubles, rather than the patient's problems, become the focus of an office visit.
Other warning signs indicating that the doctor-patient relationship may be becoming too intimate include scheduling favorite patients for the end of the day, offering free care, exchanging gifts and making arrangements to see the patient outside the office. Finally, let's talk a bit about the seductive patient described in this case scenario. After one visit, she targeted the physician to be her next husband and supporter, and father to her child.
Although the physician acted appropriately in terminating his contact with her, the patient was demonstrating enormous vulnerability and neediness.