A Matter of Situational Context?
Most doctors in our survey say the prohibition should be absolute.
"Romance is not medicine," said a psychiatrist. "Having a romantic relationship is totally against the ethical standards of the profession. It's one of the best ways I know to lose one's medical license."
For other physicians, the issue isn't as clear.
It's wrong to have a relationship with a patient if you are managing controlled substances or dealing with psychiatric or other major medical issues, said a pain specialist. "But honestly, when you're seeing someone occasionally for a minor issue or procedure, then what is the big deal?"
"A lot depends on the circ*mstances," said an otolaryngologist. "A primary care doctor who sees the patient regularly, no. But a specialist, emergency physician, or urgent care doctor who has one encounter with the patient and then will not likely see him or her regularly again—I don't think that's a problem."
A plastic surgeon remarks, "I fell in love with a patient. We were both single, both physicians, and decided to marry after dating for 1 year. We've now been happily married for 26 years."
A radiation oncologist tells of a colleague who ended up marrying a patient. "Both were widowed, and he transferred her care to a colleague before they started dating. They were together happily for two decades until he died of old age."
"The heart wants what the heart wants," said a general surgeon. "Well-educated and informed adults can make their own decisions. But in a romantic relationship, the patient/physician relationship is probably irretrievably altered, and suitable provisions must be made for this."
Changes in healthcare delivery and generational attitudes may account for the decline in the number of doctors who believe it's always wrong to get involved with a patient.
"The patient/doctor relationship is a lot less formal than it used to be," said Tommy Bohannon, vice president of sale operations for AMN Healthcare, a Dallas-based physician recruitment firm. "It's more common for care to be episodic instead of a patient seeing the same doctor for years. Also, there's a generational difference. Young doctors aren't as formal. Many don't like to wear white lab coats. They may even encourage patients to call them by their first name. That lessening of formality may have an impact on this issue."
Is a Waiting Period Acceptable?
Does a delay make a relationship ethical?
One in five doctors now say a romantic relationship is permissible—but only after a waiting period of 6-12 months, once the doctor/patient relationship has been terminated. Only 12% felt that way in 2010.
"The right answer in this situation is, don't treat people you're sleeping with," said Kenneth W. Goodman, PhD, director of the Institute for Bioethics and Health Policy at University of Miami Miller School of Medicine. "Doctors must keep their personal lives separate from their professional lives. But after ending the doctor/patient relationship, a delay of 6-12 months seems like a reasonable solution, except maybe for psychiatrists, because the nature of the relationship is different."
"Physicians really need to think through the consequences before starting a relationship with a patient, or even a former patient," Dr Goodman observed. "I'm not saying you need to be a prude, but think of how we can make sure the profession is never seen to be compromised by other considerations. There are real dangers. I know of doctors who've lost their licenses for prescribing antihistamines to lovers. Anticipate what could happen if the relationship ends badly and the other party is bitter. One phone call to the board of medicine can destroy a doctor's career. It usually just isn't worth it."
Gerald B. Hickson, MD, senior vice president for quality, safety and risk prevention at Vanderbilt University School of Medicine in Nashville, Tennessee, said that physicians should be wary even with a 12-month delay before starting a relationship with a former patient.
"I'm not rigid, but doctors should at least pause and reflect on the implications of how the relationship could affect colleagues and other patients," he said. "Never say never, but starting a relationship with a former patient requires some serious thought."
But there's a diversity of opinion on the subject. An occupational medicine doctor said, "Actually, I don't think there has to be a waiting period. There's nothing wrong in starting a relationship immediately after terminating the doctor/patient relationship."
An internist added, "It's always best to avoid going out with current patients. But when they are no longer a patient of yours, it isn't anyone else's business what consenting adults do."
