He was a California primary care physician in solo practice. The woman had been his patient for a few years, but she’d only visited his office twice. Despite their limited contact, he felt a connection to her. “I told her she’d have to find another PCP,” recalls the doctor, who courted the woman and reports that, many years later, they’re still happily married.
Although most doctors are uncomfortable with the ethics of a romance arising from a doctor-patient relationship, their numbers are declining, according to Medscape’s recent ethics survey report. Ten years ago, 83% of physicians told Medscape that a romantic or sexual relationship with a patient would never be acceptable. But in Medscape’s most recent ethics report, only 62% disavowed the possibility of such relationships, and some of them even voiced caveats.
Still, many physicians have very mixed feelings about the issue.
One mid-career female physician in California said that it’s “ridiculous to give a blanket ‘no.’ There needs to be an equal relationship, not a patient/doctor relationship, that’s all.”
“I know at least one couple who became involved this way and have had a healthy, long-term relationship and marriage, so I can’t say that it is never all right,” says a young female physician in California.
Similarly, a male physician 30 years her senior cites the case of a mentor who married a former patient. “They were both single and lived in a small town,” he recalls.
“They stopped their patient/doctor relationship, then they waited a year and started dating,” he says, so “it depends.”
Not surprisingly, those who have seen such relationships end in messy, contentious divorces or who know stories of punitive actions are stridently opposed to the idea. “Never! Grounds for losing your license”; “it could only result in trouble”; “better to keep this absolute”; “you’re asking for a horror story,” wrote four male physicians.
Although doctor-patient romances don’t frequently come to the attention of medical boards or courts until they have soured, even “happy ending” relationships may come at a cost. For example, in 2017, the Iowa Board of Medicine fined an orthopedic surgeon $5000 and ordered him to complete a professional boundaries program because he became involved with a patient while or soon after providing care, despite the fact that the couple had subsequently married.
Ethics aside, “this is a very dangerous situation, socially and professionally,” writes a male physician in Pennsylvania. A New York physician agreed: “Many of my colleagues marry their patients, even after they do surgery on them. It’s a sticky situation.”
Doctors’ Attitudes Are Shifting
The American Medical Association clearly states that sexual contact that is concurrent with the doctor/patient relationship constitutes sexual misconduct and that even a romance with a former patient “may be unduly influenced by the previous physician-patient relationship.”
Although doctors’ attitudes on the subject are evolving, that’s not to say they suddenly believe they can start asking their patients out to dinner. Very few doctors (2%) condone romantic relationships with existing patients — a percentage that has remained largely unchanged over the past 10 years. Instead, physicians are taking a more nuanced approach to the issue.
Many are questioning the idea that a doctor might have an undue influence over a former patient and are asking whether the circumstances surrounding the doctor-patient interaction should be factored into the ethical equation.
This year, more than a quarter (26%) of physician respondents said it would be acceptable to have a romantic relationship with a former patient after at least 6 months; that’s a large increase from 10 years ago.
One in ten doctors — compared to about 5% in 2010 — similarly believe that multiple factors have a bearing on the ethics of a romantic relationship with a patient. Some suggest that doctors in remote areas might have little opportunity to date outside their patient population. Others believe that doctors who provide episodic care ― such as an emergency department doctor who splinted a sprained finger or an anesthesiologist who administered anesthesia during an appendectomy — could ethically become involved with a patient after they had provided treatment because they would no longer be in a position to abuse their status.
Eroding Boundaries or Enlightened Understanding?
It’s tempting to attribute the attitudinal shift to the changing face of the physician workforce, but the numbers don’t bear that out. Overall, younger doctors ― under the age of 45 ― are more opposed to the idea of romance than their older colleagues. One reason may be that female doctors, who represent a growing share of the younger physician work force, are more averse to the idea than male doctors are.
Shifting societal mores may help explain changing attitudes. The doctor-patient relationship is more casual than it once was. Many doctors leave their white coats hanging on the back of the door and interact with patients on a more casual basis. At the same time, patients have access to more information than in the past and have been encouraged to become partners in their own care, diminishing the doctor-patient hierarchy.
In other cases, patients may feel little connection to their physicians. Life in a mobile society, computer screens in the examination room, lightning fast visits, team care, and patients’ reliance on urgent care centers mean today’s patients often fail to form tight bonds with their doctors.
And yet, there may be a simpler, more optimistic explanation behind the physicians’ shifting attitudes, says Arthur Caplan, PhD, the founding head of the Division of Medical Ethics at the NYU School of Medicine, New York City.
“For years we have pounded away at the message that romantic or sexual relationships with patients are unethical because of the unequal power dynamic,” he says. The fact that more doctors say that after the clinical relationship is over, that imbalance no longer exists indicates that the message has sunk in.
“Doctors get it,” he says. “They get the idea that the power dynamic is the issue, and as they begin to understand what the ethical objection is, they are beginning to say, ‘It’s not that I can never do that, it’s that I can’t have both a clinical and a romantic relationship at once.’ “
Is This a “Dangerous Situation?”
In fact, “the ethical analysis is pretty straight forward,” says Robert Olick, JD, PhD, a lawyer and an associate professor emeritus of bioethics and humanities at SUNY Upstate Medical University, Syracuse, New York. “There is a potential conflict of interest between being a physician and being in a romantic relationship with your patient, so you need to choose which role you are going to play.”
Resolving the ethics of the situation may not settle the legal and regulatory issues. In that regard, he says, “If you want to be completely risk averse, the answer is, don’t do it.”
For traditionalists, that hard-and-fast rule is in everybody’s best interest.
“It’s how we avoid creating problems for ourselves and our patients,” says an employed doctor in Illinois. “Without rules, we misbehave.”
Shelly Reese is a freelance healthcare writer based in Cincinnati, Ohio.
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