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What you had to
say about doctor-patient romance
"Exceptions should
be made for consensual sex if both are adults
and mentally stable. Nurses often get into relationships
with patients, as do social workers."
"There can be no exceptions
to this rule until the physician is proven not
guilty."
"We physicians have
to be held to a high standard. We need the public
to trust us if we are to do our job properly."
"The laws are way
too rigid and black & white — relationships
are more complex and not always with the MD
in a position of power."
"More education is
needed on this subject at medical school: 'How
to avoid trouble'!"
Source: NRM physician
survey comments, March 15, Vol 2 No 5
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When doctors and sexual misconduct
are mentioned in the same breath, lurid tabloid tales
probably spring to mind — like the case of Dr Steven
Dawson of Barrie, ON, the fundamentalist Christian doctor
who engaged in oral sex with a patient to whom he was
providing marital counselling. But, as Dr Dale Dewar realized
near the beginning of her career, not every case is so
cut-and-dried, ethically speaking.
Shortly after joining a medical
practice in a small Saskatchewan community, she became
the object of a young male patient's crush. "It was
odd, since I was clearly a mother and wife," she says.
When he came to see her about a knee injury and took
off all his clothes in her office, Dr Dewar did the
obvious: left the room, called in a nurse to make sure
he got dressed, and eventually assigned him to another
physician. But it got her thinking, she says. If she'd
been single, and if he'd been less unhinged, and one
thing had eventually led to another: "Would that have
been an abusive relationship?"
EXCEPTIONAL
CIRCUMSTANCES
In March, we polled readers about the suitability of
various penalties for physician sexual misconduct. Although
the majority of respondents advocated suspension of
license and/or dismissal ("zero tolerance means zero
tolerance," read one typical response), a surprising
30% supported making exceptions for consensual sex.
As one put it, "Someone should support the right of
legally competent adults to make their own decisions,
not look for ways to remove that right 'for their own
protection'."
Among those who felt exceptions
ought to be made for consensual relationships, most
included stipulations: the doctor/patient relationship
has to stop, for example, and such relationships are
more acceptable in isolated communities where the doctor's
chances of socializing with people who won't eventually
end up in their waiting room is low.
According to Dr Trina Larsen-Soles,
president of the Society of Rural Physicians of Canada,
the point about isolated communities is a good one.
"Boundary issues are challenging in small towns," she
points out. "Not just in terms of romantic or sexual
issues, but also in terms of friendships and where you
go to get your car serviced. When you literally know
everyone in town, how do you have separate professional
and personal relationships?"
Dr Dewar feels that a lot of the
danger goes back to the public's larger-than-life view
of doctors. "People tend to see doctors as almost magical,"
she says. "Traditionally, the medicine man or woman
held a powerful place in society, but didn't have many
social relationships." Even now, relationships can be
distorted by this inequity, especially in small communities.
As Dr Larsen- Soles observes, "You can never really
let your hair down, because you're never sure when a
friend might turn up as a patient."
GUIDELINES
VARY
It's this power imbalance, of course, that gives rise
to concerns about sexual misconduct, even where consensual
sex is concerned; but guidelines for managing it vary
from province to province. In Saskatchewan, for example,
the College leaves it up to the individual doctor's
discretion. In Ontario, the rule of thumb (currently
under review) is never for psychiatric patients, wait
a year for most regular patients, and less for a patient
a doctor's seen only once, for example in the emergency
room.
For Dr Dewar, even Ontario's one-year
'cooling-off period' presents difficulties, given the
vagaries of human emotion. "How do you know when you're
becoming romantically involved? It's not always clear-cut.
There's some kind of wisdom that
physicians are expected to demonstrate, that nobody
else in the population has."
Obviously, the biggest problem
lies with younger, single physicians, some of whom end
up moving back to the city when they realize how tough
it is to date in the country. "One young doctor told
me that he had probably treated every single woman in
the community, mainly gynecological examinations," Dr
Dewar recalls. "So it would be inappropriate for him
to have a social relationship with any of them. But
what if he later finds himself working on a non-hospital
project with one of them, and a relationship starts
to form? I would say that's okay as long as he doesn't
do her next Pap smear."
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