Dating patient ethics

Would you — acting on behalf of the state board — take action against this doctor's license for the offense of providing an antibiotic sample to a current lover? As this example demonstrates, the "no overlap" rule can be unworkably blunt, even in traditional settings.

Managed care may compound the difficulty, when a limited panel of physicians presents a patient with an "ineligible" doctor as the only covered choice.

A therapist who gratifies his or her own needs by exploiting a patient's vulnerability destroys the trust essential to treatment." The APA seems to imply that all sexual relationships are inherently exploitative. From the administrative justice standpoint, a "no overlap" rule is simple to administer and superficially unassailable. As a credentials reviewer, I've seen this clause invoked far more often by scorned lovers than by innocent parties.

The inflexible letter of the law weighs unfairly on some defendants, and sometimes compels a disciplinary body to impose sanctions that don't fit a case's nuances.

Sexual or romantic relationships between a physician and a former patient may be unduly influenced by the previous physician-patient relationship.One could argue that married couples are an exception,but that view requires an understanding of relationships that is absent from the "no overlap" policy.Physician-patient romance deserves a sophisticated and courageous ethical analysis. Rules are always problematic, especially those that address highly complex human behaviors.I would argue, I think with good support, that love and mating entail the greatest complexity of anything we do as a species.As a married couple, we both could be found guilty of unprofessional conduct by a fundamentalist reading of our state statute, on a strictly scriptural basis. There is a well-founded ethical and psychological basis for a general proscription of sex between doctors and patients.Scurrilous cases do come before disciplinary boards, in which truly abusive or criminal conduct has occurred. But the absolute, literal terms in which these issues often are addressed don't always do justice to the range of behavior that I could accept as a member of the profession.Our contemporary attitude toward such encounters is to label them, categorically, as "unprofessional conduct." Given that there is no surveillance of this behavior, physician-patient sex comes to the attention of regulatory agencies only when the patient complains. The nominal standard establishes a rule of "no overlap": a physician-patient relationship must not coexist with a romantic-sexual relationship.The AMA says: "Sexual contact that occurs concurrent with the physician-patient relationship constitutes sexual misconduct.In an effort to refine how the "no overlap" principle should be applied, I'd like to throw a small monkey wrench at this naively simplistic construct.In reducing human behavior to coldly formal, mechanistic terms, we tend to get tripped up.

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