A romantic or sexual relationship with a patient is vehemently taboo for the vast majority of doctors, although many have admitted that they were sometimes tempted, and a minority believe that there could be circumstances when it's acceptable.
Responses covered the entire spectrum: "Under no circumstances." "This is morally reprehensible." "It would be acceptable if the patient was no longer under your care for at least 1-2 years." "If I were providing incidental contact, it would probably be okay at any time," and "it's acceptable if both are single adults" -- although the overwhelming majority, 83%, said that it was simply not right.
These are just a few of the diverse responses to an exclusive Medscape ethics survey that asked physicians of all specialties: Could you become involved in a romantic/sexual relationship with a patient? The survey ran from August to September 2010, and more than 10,000 physicians responded.
Some respondents were very emphatic, stating that "having sex with a patient is the worst thing you can do to a patient. It's totally exploitative and wrong." Also, "it is wrong to take advantage of another person. I learned that in first grade." Further, "it will always begin with unequal power." Less than 1% of respondents said that they had no objections to having such a relationship with a patient, whereas 4.5% said that "it depends" on the circumstances.
Doctors took the unequal status of patient and physician very seriously. One doctor put it succinctly: "The physician will acquire knowledge of the patient's weaknesses and strengths more so than the patient will know about the physician. The knowledge acquired by the physician during the patient-doctor relationship gives the physician an unfair advantage."
Physician Ethical Codes Are Against It
Such insights echo the concerns stated in the ethics codes of 2 major medical associations. The American Medical Association's (AMA's) Code of Ethics states: "Sexual contact that occurs concurrent with the patient-physician relationship constitutes sexual misconduct. Sexual or romantic interactions between physicians and patients detract from the goals of the physician-patient relationship [and] may exploit the vulnerability of the patient."
Likewise, the American College of Physicians' Ethics Manual has taken the position that:
Issues of dependency, trust, and transference and inequalities of power lead to increased vulnerability on the part of the patient and require that a physician not engage in a sexual relationship with a patient. It is unethical for a physician to become sexually involved with a current patient even if the patient initiates or consents to the contact.
Kenneth Goodman, PhD, an ethicist at the University of Miami, Miami, Florida, points out, however, that an inequality of power is only 1 of many serious issues with which to contend. "Physicians need to be dispassionate when caring for their patients. In other words, they can't allow their clinical judgment to be clouded by personal concerns, lest those concerns hinder their ability to provide the correct diagnosis and treatment." However, when a clinician is caring for someone with whom he or she has a special relationship, whether it be a mother, brother, or lover, it is much more difficult to be objective.
Similarly, it is often difficult for a patient who is romantically involved with his or her physician to be candid about medical issues. For example, it's unlikely that a patient who develops a sexually transmitted disease will be forthcoming about it with a physician if the patient has a sexual relationship with the clinician.
However, even on more mundane matters, openness can be compromised when a close relationship exists between doctor and patient. Even confessions, such as "I haven't stuck to my diet"; "I haven't exercised"; or "I didn't get the test you ordered," may be uncomfortable for patients to admit in such circumstances, says Dr. Goodman.