Nurse dating former patient

She says she must transfer her care to another institution because the possibility of seeing this physician, or one of his colleagues she met while involved, is so unsettling.

A sexual relationship with a current patient is unequivocally forbidden in all codes of medical ethics, going back to the Hippocratic Oath: “In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men.” However, is it a serious breach of ethical standards if, as in this case, there is no ongoing physician-patient relationship?

The American Bar Association, for example, although taking a dim view of these relationships, does not absolutely rule out the possibility that a client has given effective consent: The lawyer may be called upon in a disciplinary or other proceeding to show that the client consented, that the consent was freely given based on full and reasonable disclosure of the risks involved, and that any ensuing sexual relationship did not in any way disadvantage the client in the representation; that is, the attorney's judgement remained independent, the representation proceeded free of conflicts, the privilege was not compromised and the other ethical obligations to the client were fulfilled.

primary care physician sees a woman whose regular doctor is out of town.

She comes in for a refill of zolpidem tartrate, which she is taking for insomnia.

Why then does the AMA absolutely prohibit sexual relationships with consenting adult patients?

Perhaps it would be too expensive or time-consuming to scrutinize the propriety of these relationships and the effectiveness of consent on a case-by-case basis.

But the AMA takes the position that ending the professional relationship may not be enough: a relationship still may violate professional ethics "if the sexual contact occurred as a result of the use or exploitation of trust, knowledge, influence, or emotions derived from the former professional relationship." When would this be the case?

The only other guidance that the AMA gives is of little help: Relationships between patients and...

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.

She is otherwise completely healthy, and after confirming that her primary doctor has prescribed it, the physician refills her medication for a few days until the other physician returns.

The physician engages the patient in a brief discussion of the life stresses contributing to her insomnia, but no physical exam is performed.

If I were part of a disciplinary committee reviewing this case, I would have to conclude there was a violation of professional standards.

Tags: , ,