During my last job, one of my regular patients and I seemed to hit it off I was pleasant and friendly, but kept it professional. I definitely felt the tension and I think we both knew there was some chemistry there. At the time, I was working in a field that I would not consider terribly invasive, nor unusual relationship such as psychiatry, just a typical office. I am no longer at that practice and have no intention of returning, nor do I live in the area of my practice or know anyone in common with this former patient, no complicating factors.
The universe does not owe us "relationships" I recall too that the attitude was, "that's not what you're there for.
There was a great emphasis on the fact that the relationship was all about what the patient needed - that we shouldn't be talking about ourselves, but rather that we should keep it professional based on what the patient needed. Now if either party expressed interest while the pt was inpatient, you could get sexual harassment issues in there. If the focus was on the two of them, there would be less attention paid to whether the pt was having symptoms.
Would Dr. Smith Make Life Hard for Ms. And what about the baby? Anyway - point being - keep it professional! And I can't see a smooth transition when the pt gets taken out to the car at the end of their stay! But there are others who have more finesse than I. I think alot has to do with the scenerio that made the pt a ptSay Nurse Suzy is taking care of Patient A who just had an appy.
Pt A tells nurse Suzy he was supposed to go to the blues concert tonight but now cant, Nurse Suzy says Oh I love that blues band etc etc etc and a conversation begins, a few weeks later nurse Suzy and Patient A are now at the same bar watching the same show and Pt A buys nurse Suzy a drink and a relationship begins Or Nurse Suzy is taking care of Pt B in the Behav Health unit, had read pts Bs chart about his past relationship troubles-job trouble etc etc etc and Nurse Suzybeing a bit crazy her self lol and thinks Pt B is "hot" so she calls him after he is dismissed at home to "just talk" and see how he is doing etc etc etc and a relationship begins, well this is bad if you ask me.
There are definitely grey areas here. If they leave your facility entirely, but still remain a pt over in the rehab center, or are still a pt of one of the docs on your floor However, I would still avoid calling them to "check up" when you really have an ulterior motive. Unless you expect to continue to have to care for them - i. I too am happily married, so this is the first time I've sat down and thought any of this through.
It wasn't covered at all at my school, and I did have to take a nursing ethics class.
I have never dated or been involved with a patient, or even a former patient, not that I am aware of. I think part of the 'never ever ever date a patient' rule from nursing school has to do with the stigma of nurses as 'professional' women wink wink nudge nudge. If she's not at home, she must not have any honor I think the world's changed enough that that mentality is pretty much gone, but it seems like nursing school is often the last institution to notice social changes.
Nope, it's far more serious than that. It has to do with the problem of using a professional relationship to meet one's own needs. The emotional bond established during the caregiving relationship is, almost by definition, an artificial one resulting from our professional duty to care and the patient's natural reaction to being cared for. It is unethical to exploit that bond to meet the professional's personal needs The question is, how long does one wait after the end of the professional connection to approach the former patient?
Jan 05, A majority of doctors responding to a recent ethics survey say romantic relationships with patients are off-limits. Doctors are expected to keep a professional boundary between themselves and. Apr 10, In Medscape's Ethics Survey, more than 24, physicians told what they think about becoming romantically or sexually involved with a patient. Their responses may surprise you. Dec 02, "A relationship between a doctor and a patient is never really equal" argues the GMC's president, Graeme Catto. 4 By prohibiting behaviour that is not in the best interests of patients, codes of ethics have enabled doctors to concentrate on doing the best for their patients. In this way, the power of the doctor is harnessed to the good.
Share this post Link to post Share on other sites. Oct 10, by Atheos. Here is my take. I believe you can apply this to the current situation. Oct 10, by Liddle Noodnik. Oct 10, by patwil But, I have seen a few fruitful relationships develop this way.
So do you remember when you were taught why it was wrong? Thanks Pat. I dont think this is a black and white question.
The relationship between a patient and a physician is based on trust, which gives rise to physicians' ethical responsibility to place patients' welfare above the physician's own self-interest or obligations to others, to use sound medical judgment on patients' behalf, and to advocate for their patients' welfare. Ethics dating patients - Join the leader in mutual relations services and find a date today. Join and search! Find single woman in the US with footing. Looking for romance in all the wrong places? Now, try the right place. Rich woman looking for older woman & younger man. I'm laid back and get along with everyone. Looking for an old soul like myself. Oct 03, According to the American Medical Association (AMA) Code of Medical Ethics, romantic or sexual relationships between physicians and patients are archotelzeeland.com brief entry reads in part that "A physician must terminate the patient-physician relationship before initiating a dating, romantic, or sexual relationship with a patient." 1 In the United Kingdom, the General .
Lots of grey areas!!! But good topic though!! Oct 10, by MB Katherine H Hall, Sexualization of the doctor-patient relationship: is it ever ethically permissible? Whilst having sexual relationships with current patients is clearly unethical, the ethics of such a relationship between a doctor and former patient is more debatable.
In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor-patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient.
Only in very particular circumstances could such relationships be ethically permissible. Hall KH. Sexualization of the doctor-patient relationship: is it ever ethically permissible?
Family Practice ; - All codes of ethics set up by medical professional bodies prohibit sexual relationships between a doctor and a current patient. Although this stance initially provoked a degree of controversy within the country, 2- 6 the deleterious effects of such relationships upon patients have become increasingly recognized and condemned by the medical community.
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.
Ethics dating patients
This paper presents evidence from international medical and ethical literature to examine the validity of this position taken by the New Zealand Medical Council regarding the sexualization of relationships with former patients. First, the concepts of boundaries and transference are discussed and a profile of the medical practitioner at risk of offending is drawn. Secondly, three cts of the doctor-patient relationship are explored: the general characteristics which promote health care; the importance of trust and the fiduciary relationship; and the role of power and authority in the relationship.
Thirdly, a discussion of the role of autonomous choice and consent is presented.
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: after all, the crossing or erosion of boundaries is a normal part of the evolution of intimate relationships between human beings.
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. 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.
Therefore, unmet emotional needs of the doctor, overidentification with the patient and particularly intimate areas of medicine associated with long-term professional relationships with patients can all potentially enhance the strength of the transference-counter-transference relationship between doctor and patient.
Psychiatrist/patient boundaries: When it's OK to stretch the line
Transferences per seas 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.
The fiduciary relationship relationship of trust is a crucial ct of the doctor-patient relationship. 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.
It has also been suggested that another source of power -Hierarchical power, the power inherent by one's position in a medical hierarchy e.
To help understand these four types of power, and the relationships between each type, consider the following incident from my personal experience as a first year house surgeon in Australia in the mids.
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. Despite having the Aesculapian power of a doctor, and the Social power of a hospital specialist, in addition to considerable Charismatic power he was a well-liked and respected colleaguenone of these were sufficient to counteract his lack of Hierarchical power by being a patient.
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.
Therefore, the onus of responsibility for controlling the power imbalance in an ethically correct manner is always on the doctor. However, what is the relevance of this analysis to relationships with former, not current patients?
Several points can be made. Information gained in such a power imbalance can be artificially intimate-one does not normally begin to discuss details of sexual function within a few minutes of meeting a stranger, for example, but this frequently happens in general practice consultations. Secondly, given the strength of Hierarchical power in determining one's overall power in the doctor-patient relationship as illustrated by the case historyit is hard to see how a relationship of equals could develop from such unequal beginnings.
How should a claim be judged that a former patient gave his or her free consent before entering into the relationship? The validity of consent of a former patient, as opposed to a current one, is a little more debated, but evidence is against that being a former patient materially alters the situation.
Not all authors condemn sexual relationships with previous patients however.
Oct 27, Ethics on Ending the Patient-Physician Relationship. October 27, Once you accept a patient into your practice, you are under an ethical and legal obligation to provide services to the patient as long as the patient needs them. There may be times, however, when you may no longer be able to provide archotelzeeland.com: Martin Merritt. Apr 28, The ethics of patient-physician relationships are an important topic of discussion in health care. Find out more about doctor-patient relationship ethics with . Dec 31, Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship.* (AMA Code of Medical Ethics, Opinion )**The AMA stipulates that a former patient may still be influenced by the previous relationship and may not.
Zelas is a little less prohibitive. In the earlier discussion, it was argued that the power imbalance of the doctor-patient relationship would continue into the sexualized relationship. Other arguments support the idea that meaningful consent is an impossibility in this situation.
Traditional teaching of informed consent emphasizes the importance of autonomous choice, i. Leaving aside the provision of information presumably such information should include a review of the current known research in this area, although this apparently rarely, if ever, happens 12this discussion will concentrate on coercion and impaired capacity.
Coercion can arise from imposed restraints on any or all of three types of autonomy: autonomy of thought or the ability to think for oneself, autonomy of will or the freedom to make a choice based on one's own deliberations, and autonomy of action or the freedom to enact one's choice physically. However, an alternative definition of autonomy which centres upon the importance of one's social relationships demonstrates a more subtle source of coercion.
Brody argues that the distinguishing characteristic of general practice ethics, as opposed to hospital-based ethics which involves a time-limited decisional focusis the longitudinal relationship which develops between doctor and patient. From both these arguments, then, it can be seen that attention to relationship is particularly important when considering general practice ethics. It could be argued, therefore, that general practice has a particular duty of fostering the autonomy of the patient and that a GP's actions should be evaluated in the light of this duty.
Sexual misconduct with a former patient does not, by any established evidence, foster patient autonomy, and a doctor participating in such a relationship is thus breaching this duty. It would be the minority of consultations, especially in general practice, where the above conditions of persistent transference and power imbalance did not exist.
Certainly the onus of proof, in any disciplinary hearing, would lie with the doctor to demonstrate how these ethical issues were of minimal impact in the subsequent sexualized relationship. Only in situations where there was a minimal potential for transference-counter-transference to arise, together with an unusual equality of power, could the former patient be in a position to exercise true autonomy and choice when entering into a sexualized relationship with the doctor.
In general, the criteria by which the New Zealand Medical Council will judge the ethical acceptability of sexual relationships with former patients 7 appear to be necessary, but not sufficient. They have correctly identified several situations where the likelihood of significant and persistent transference-counter-transference, and the perpetuation of a significant power imbalance in the relationship, is very high.
However, other situations may well occur which fall beyond these criteria but nevertheless have a similar degree of transference-counter-transference and residual power imbalance so that a sexualized relationship is equally as abusive as the listed criteria.
It is these underlying factors, rather than any more superficial descriptors, by which the ethical acceptability should be judged.
This being the case, relationships with former patients should not be regarded as ethically permissible except under such rare circumstances. The author wishes to thank Dr Chrys Jaye for reviewing an earlier draft of this paper and for her very helpful comments and suggestions.
New Zealand Medical Council. Cullen RM. Medical discipline and sexual activity between doctors and patients. NZ Med J ; : - Sexual activity between doctors and patients [letter]. White G. NZ Med J ; : Cullen R. Medical discipline and sexual activity between doctors and patients [letter]. Northwood B. The concept of boundaries in clinical practice: theoretical and risk-management dimensions. Am J Psychiatry ; : - Simon RI.