Toto, We're Not in Kansas Anymore, or Texas, Or Seattle Grace Hospital, For That Matter
For as much as it might seem okay for as much as it happens in prime time TV medical dramas or daytime soap operas, there doesn't seem to be a medical board out there or the American Medical Association, for that matter, that thinks it's okay for doctors to have a romantic relationship with patients. Even when it's consensual between two adults. Not while there is a physician-patient relationship that is ongoing.
It may be okay to have a round of golf or have a drink with someone at a bar, but if you want to date or have a sexual relationship--that's right out.
But Chris Rangel, MD of RangelMD.com seems to have a problem with this view. He disagrees with the Texas Medical Board's recent decision to fine a doctor $10,000 and to have him do 10 WHOLE hours of ethics education over two years (how ever will he find the time to do that??) after engaging in a romantic relationship with one of his patients. His reason? It's simply too excessive.
If this physician had just terminated his physician-patient relationship prior to having a romantic one, the problem could have been solved, as was pointed out at the New York Times Tara Parker-Pope blog and by Rangel himself. I agree.
You can't control who you fall in love with or even who you want to date, but you can put on the speed breaks long enough to say, "Hey, please find another doctor before we take this any further." Particularly in this case, when the physician in question is a family practitioner, not an orthopedic surgeon or a specialist, but a dime-a-dozen family practice doc. How hard would it have been, one has to ask, for this physician to have given his patient a referral prior to engaging in a sexual relationship with her and avoided entirely this ethical misstep? Had he been the only hematologist in town and she had anemia, the ethical violation would have been of a totally different kind--but in this case, this physician simply didn't bother to ask her to find a different primary care doctor.
Ultimately, he will take his ethics courses and pay his fine and go on with his practice. But hopefully, other physicians will learn from his mistake. Yes, you can fall in love with a patient as they do on primetime TV, but before you take the plunge, give them a referral first.
Summer Johnson, PhD
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Absolutely right!
The only caveat is that, I believe tht in some places, at least, docs are required not just to terminate the professional relationship, but to *wait* a while, too. Some places forbid romance with someone who has been a patient within the last 2 years.
- by Chris MacDonald on Apr 23, 2009 at 2:20 PM | link
I agree with Summer Johnson that such behavior is unethical and have argued for that view (with respect to sexual relations in psychotherapy) in my book -- Exploitation. Nonetheless, I think that such discussions should include some account as to WHY such behavior is wrong. Citing an AMA code may show that it violates the code, but does not provide an ethical reason. I believe that while one can make a defensible argument as to why such behavior is wrong, it is more difficult than is often supposed. Is it wrong despite the fact that it might be consensual? Or is it wrong because the consent is not likely to be valid? I would have liked to hear more.
- by alan wertheimer on Apr 23, 2009 at 4:14 PM | link
Alan, thank you for your comment. As for my own view, as opposed to AMA's, I think that physicians engaging in a romantic or sexual relationship with a patient effects THEIR objectivity in regard to treatment and therefore will compromise their ability to treat that patient well. From the patient's perspective, they may not feel comfortable questioning the care they receive and therefore have their care compromised in a way that they would not were they not in a dual-role relationship with their physician. It is the responsibility of the care provider to end either the romantic relationship or the healthcare relationship for the good of the patient before their care is compromised as it is the objectivity of the physician at stake, much more than the vulnerability of the patient, their consent or any other problem in the physician-patient dyad. What say you, Alan?
- by Summer Johnson on Apr 24, 2009 at 2:40 AM | link
Thanks for this comment, Chris. I did not know this. Do you know in which states this is the case? And/or is this true in Canada?
What is the justification for this "waiting period"? If the physician-patient relationship has ended, one would think that the physician should be free to do as he/she wishes. This requirement seems rather stringent to me and an infringement on civil liberties and the right of free association.
Summer Johnson, PhD
- by Summer Johnson on Apr 24, 2009 at 2:44 AM | link