Is It the Patient's Fault?
He doesn't like using the term "seductive patient" because it implies that the patient is responsible. "Physicians are 100% responsible for maintaining boundaries in a physician/patient relationship," he says.
Dr Schenthal prefers the term "enticing patient." Patients who entice physicians, he says, are not necessarily seductive. In many cases, they may simply be looking for a close relationship with the doctor, or they are just naturally flirtatious and are not looking for sex, he says.
He also objects to using the term "affair" to describe a doctor/patient romance, because it implies a mutual decision. Dr Schenthal says the relationship could never be truly mutual because physicians have such great power over the patient. Indeed, this view is very widely held throughout the physician-treatment community.
When doctors come to PBI classes on boundaries, Dr Schenthal says, they begin to recognize that as much as the patient may have tried to seduce them, "the doctor seduced himself." He says this self-seduction involved doctors convincing themselves that the long-standing taboo against having sex with your patients, which goes back to Hippocrates, was somehow not applicable in their situation.
Stephen M. Boreman is a San Francisco attorney who spent a decade representing the Medical Board of California in disciplinary cases against physicians, and he now does work for PBI. He says many patient/doctor sex cases that come before the board are "more or less mutual," and do not appear to be initiated by the patient, although he adds that it's not always clear who the initiator was.
Boreman doesn't see much romance in these patient/doctor liaisons. "They're not falling in love," he says. "They just wanted to have sex."
When the relationship ends, physicians can't expect much loyalty from their former partners, says Kenneth W. Goodman, PhD, director of the Institute for Bioethics and Health Policy at the University of Miami Miller School of Medicine. Former patients or their spouses might file a complaint with the medical board. "You have to be leery about what could happen if this thing goes south," he says.
How a Seduction Unfolds
Doctors who respond to patients' advances are "wounded healers" overwhelmed by personal problems, and their judgment is affected, Dr Schenthal says. "When you are in a period of imbalance, you can be vulnerable, and you may lower your guard," he says.
These doctors are no longer engaging in moral reasoning. "Doctors are usually very rational beings, but when your emotions are in play, when you get aroused, you enter a 'hot state,' and you process a moral dilemma very differently than you usually would," he says.
He says he has seen some very distinguished doctors—renowned researchers, deans of medical schools—ignore their better judgment and engage in illicit sex.
For the sexual relationship to happen, the doctor and patient have to break through multiple boundaries that kept the relationship exclusively therapeutic, Dr Heitt says. They might start by talking more and more about their personal lives in the office visit. The patient might then be scheduled for the end of the day, so that they could talk longer. Then they may agree to meet at a coffee shop or restaurant.
"Outside of the office, you no longer have the role of the doctor," Dr Heitt says. "You're not wearing your lab coat and tie." The doctor may not have done anything sexual, but "now there's a huge potential for that."
As an example of what can happen when you accept a patient's invitation, Boreman points to the disciplinary case of a California ob/gyn. A young patient of his said she wanted to interview him at a restaurant about his experiences as a doctor. After they ate dinner together, he walked her to her car. A handshake turned into an embrace and she groped him. He told her he couldn't have sex with her because she was his patient, but he got into her car and they fondled each other for some time.
The woman stopped being his patient, and after several months, he contacted her and they dated. After they broke up, she filed a complaint against him with the medical board about the encounter. The doctor argued that it was brief and unintended, and it did not involve more than touching. An administrative law judge recommended that the charge be dropped, but the medical board imposed a public letter of reprimand.
The doctor appealed the action, noting that the patient had seduced him. The court rejected his appeal, stating, "The idea that a physician could, with legal impunity, receive sexual favors from a patient as long as he does not return them would, in our view, create a loophole in the statute that the Legislature could neither have imagined nor intended."
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Cite this: Leigh Page. When Patients Try to Seduce Doctors - Medscape - Oct 26, 2016.