When Is It Okay to Date a Patient? Medscape Ethics Report 2012

Shelly Reese

Disclosures

November 15, 2012

Introduction

To the besotted poet, love is intoxicating, exasperating, invigorating. To the doctor -- if the would-be paramour is a patient -- it's also unethical.

But physician responses to Medscape's 2012 ethics survey clearly indicate that many physicians aren't willing to condemn every romance. When asked, "Is it ever acceptable to become involved a romantic or sexual relationship with a patient?" more than two thirds (68%) of the 24,000 doctors who responded resoundingly say "no."

In contrast, nearly one third are more nuanced in their view. Only a tiny minority (1%) give romance with current patients a green light, but a sizable share (22%) say that a romantic relationship with a former patient may be acceptable, as long as at least 6 months have passed since the professional relationship was terminated. Another 9% say the ethics depend on the situation.

Whereas the American Medical Association (AMA) clearly states that sexual contact that is concurrent with the doctor/patient relationship constitutes sexual misconduct, it takes a fuzzier position on relationships that might develop later. The AMA notes that the prior doctor/patient relationship may unduly influence the patient and that such a relationship is unethical if the doctor "uses or exploits trust, knowledge, emotions or influence derived from the previous professional relationship."[1]

Ethicists, such as Dr. Richard Martinez, director of forensic psychiatry services at Denver Health Medical Center and the author of several articles on ethical decision-making and the patient/physician relationship, says the AMA was wise to leave a little wiggle room in its opinion.

"Relationships are complicated," he says. "Every ethical dilemma has to be evaluated and considered on a case-by-case basis."

When a Potential Romance Depends on the Circumstance

That simple "it's complicated" answer captures the spirit of nearly one third of the respondents' remarks. Whereas many qualified their answers with caveats that they themselves would not engage in such a relationship and that "99.9% of the time" having a relationship with a patient is verboten, "there are weird instances in life when I can see this happening," wrote one general surgeon. "Of course, the physician-patient relationship would have to end."

Many make the important distinction that the intimacy or longevity of the professional relationship plays a large role in determining the ethics of the personal one. Not every patient interaction with a physician is emotionally deep, nor is there an innate imbalance of power. A patient may well have a closer, more dependent relationship with her auto mechanic than with the dermatologist she once visited to have a plantar wart removed. Similarly, a patient may not even remember the anesthesiologist who presided over his gallbladder surgery or the emergency department doctor who once stitched his finger.

"I think it depends in part on the type of physician and medical care," says a pediatrician. "For example, I would be less concerned about an ophthalmologist getting involved with a patient who has had general yearly visits than I would an internist or oncologist."

Likewise, "the fact that you met them as a patient once in an ER, or you cared for them years ago and they are no longer your patient should not be absolute barriers to a relationship if it develops," wrote an obstetrician/gynecologist.

Ethicists say the distinction is valid. Some specialties by their very nature create a more intimate relationship, and one that makes the patient more vulnerable. Recognizing that, the American Psychiatric Association categorically prohibits sexual relationships with either current or former patients.

The difference between treating a "boo-boo" -- as opposed to a patient's depression or cancer -- can't be overstated, says Kenneth Goodman, PhD, codirector or the University of Miami Ethics Programs.

Dr. Martinez agrees. "You definitely have to dissect the relationship," he says. Whether or not a relationship could be ethically defensible depends on the nature, intensity, and frequency of the doctor/patient interaction, he says.

A handful of respondents note that an amorous relationship with a patient might be allowable for physicians in rural areas, where everyone's a patient, but such ethicists as Dr. Goodman are less sympathetic and advise country doctors to "find someone in the next town over," rather than muddy the legal and ethical waters.

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