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Can a single visit make a patient vulnerable to exploitation?

If a doctor sees a patient while he's covering for her absent primary care physician just to issue a refill on some sleeping tablets, does that constitute a physician-patient relationship that's strong enough to take advantage of the patient's vulnerabilities?

What if nothing untoward happens at that exam, but they meet up again some weeks later in a social setting and the patient asks the doctor out? Should he refuse despite the patient's objection that there's no real doctor-patient relationship?Absolutely. Furthermore, if he doesn't refuse and the patient later feels taken advantage of emotionally, the doctor is the one who is likely to be held accountable.

Unfair? Not really. Consider this:

  • During the patient's brief visit, the doctor discussed the patient's ongoing need for the sleeping tablets.
  • In doing so, the patient had to confide in him the things that are keeping him or her from sleeping. Those could be things that the patient has told no one except the primary care physician.
  • Even if the doctor only exhibited the ordinary level of concern and compassion demanded by his or her profession, that could have played into a sensitive patient's need for emotional support during a trying time.
  • That sense of emotional support could be what led the patient to seek the romantic relationship.
  • If the relationship turns out to be nothing more than a casual fling, the patient is apt to feel incredibly betrayed and less trusting of doctors in the future.

There's a very good reason that the Hippocratic Oath has always put an emphasis on avoiding sexual relationships with patients. Anyone in a fragile emotional or physical position can be more vulnerable to the influence of others and less apt to make wise choices for themselves.

That puts the responsibility on the physician to set the boundaries. A physician in the situation described above is apt to face suspension and have to take retraining on ethics. In addition, he or she is going to have to explain the situation in the future anytime there's a reason to address his or her credentials or license.

If you're ever in a situation where you question the appropriateness of a relationship with someone you saw even once, talk it over with another professional or colleague in order to get his or her take on the situation. The inconvenience certainly beats having to defend your professional license formally later.

Source: ACP Hospitalist, "Romantic relationship with former patient: Drawing the line from the start," Lachlan Forrow, FACP, accessed Jan. 02, 2018

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