Ethicists, such as Dr. 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.
Ethicists say the distinction is valid. Some specialities 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.
Martinez agrees. Does a coincidental meeting at a cocktail party where you engage in a personal conversation constitute the. What if you attend the same church? Play in the same tennis league? Have children in the same school? Many such relationships simply atrophy with inattention. Thus, physicians must remain closed to the possibility of such involvement with patients in order to approach all encounters in an entirely professional manner.
If a patient and a physician disagree about whether an intimate relationship involved exploitation of an earlier professional interaction, then with few but not zero exceptions, the patient's judgment should and will prevail. If I were part of a disciplinary committee reviewing this case, I would have to conclude there was a violation of professional standards.
To do otherwise would show insufficient seriousness in upholding strict professional limits. I would do this with some discomfort, because it would likely mean that on future applications for licensure or credentials the physician would have to report that he had been the subject of disciplinary action and explain the details.
It is impossible to define exact boundaries between acceptable and unacceptable behavior in this area. I might, for example, reach a different conclusion if the clinical interaction involved a minute or two to remove a splinter from a finger, rather than a discussion of the patient's emotional stresses. As a practical matter, physicians should assume that any prior physician-patient relationship is incompatible with a subsequent sexual relationship.
In reviewing the case, the medical center's disciplinary committee determined that the physician, while highly regarded by all of his colleagues and never the subject of any prior complaint, had violated ethical standards of professionalism. He was placed on probation for one year and required to undertake study of codes of professionalism.
Please email your comments on this case, or any suggestions for future case studies, to acpinternist[EACHAT]acponline. The opinions expressed in this column represent the views of the contributor and do not reflect the opinion of the American College of Physicians or the ACP Ethics, Professionalism and Human Rights Committee.
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