Secondly, three aspects of the doctor–patient relationship are explored: the hugs, kissing); extratherapeutic contacts occur; dating begins; sexual intercourse . Similarly, the American Medical Association (AMA) highlights that any prior doctor-patient relationship may unduly influence the patient. A watchdog has updated its guidance on doctors having romantic relationships with their former patients, urging medical professionals to use.
Yet, this does not address the obscurity of the guidelines. From an administrative justice standpoint, the rules and guidelines seem simple to administer and superficially unquestionable.Doctor Checkup : feeling tired want Relex #PhysicalExam
But setting ethical boundaries is rarely perfect — as the rules address extremely complicated human behaviours.
The inflexibility of the law weights unfairly on some parties, and is sometimes forcibly applied on cases whose circumstances do not fit. Take for example, a single doctor practicing in a rural small town.
As the doctor is likely to be the main caregiver of the town, almost anyone is a potential patient. Therefore, if said doctor starts courting a local man or woman, he or she would have run afoul of the rules — leaving the doctor an option to date residents of the next town only. Does the local resident need to ask for an out-of-network referral?
To love or not to love: Debating a romantic HCP-patient relationship
Note that it is not the geographic reality, but rather the contractual restriction that forms the ethical bind. I have yet to hear of any incidences, neither have we read anything in the press. What if a relationship turns sour? The patient might turn on the HCP.
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.
- Doctors allowed to date former patients
- To love or not to love: Debating a romantic HCP-patient relationship
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.
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.
Can a Doctor Date a Patient?
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 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.
Can a Doctor Date a Patient? | Futurescopes
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. Charismatic power may not always be less on the patient's side depending on the personalities of patient and doctor.
Equally, Social power may vary in doctor— patient relationships depending on the social status of the individuals. This may also relate to the gender roles of the patient and doctor.
The large majority of cases of sexualization occur between female patients and male doctors.