When I was in medical school, students and faculty congregated weekly in small groups to discuss the "softer side" of medicine. The impact of addiction, what it's like to live with a chronic disease, the experiences of centenarians, the doctor-patient relationship — we discussed it all, often with patient volunteers who joined us to share their perspectives.
One Tuesday, the conversation drifted toward whether a physician dating a patient could ever be appropriate. Several people were caught off-guard — not by the topic, which is important, but by the stance of two students who argued forcefully that there was no good reason to prohibit those relationships. The faculty and several others responded vigorously, explaining eloquently why society and licensing boards view that sort of interaction as wrong.
That conversation has stayed with me. It's important to me that every physician — in fact, every medical professional — understand a fundamental principle guiding the doctor-patient relationship.
#MeToo in medicine
Comedian Lane Moore recently started a revealing conversation on Twitter when she asked:
"[R]aise your hand if you're a woman who has been hit on by a medical professional ... nowhere is safe." She continued, "[H]aving this happen can make you avoid doctors/medical care, because you want to keep yourself safe, which can lead you to missing a medical issue." Numerous replies from others made it clear that women are having uncomfortable experiences in healthcare all the time. These were just the women who were willing to speak up — there must be many others who were unwilling to raise their hand in a public forum.
#MeToo brought to the forefront what many already knew firsthand: Inappropriate sexual conduct by a powerful individual is destructive. Recall the crimes of former doctor Larry Nassar — as NPR reports, his one-time employer, Michigan State University, reached a $500 million settlement following hundreds of abuse claims. His actions appall most physicians. What we may not realize, however, is that it doesn't take outright sexual abuse similarly violate patients' trust and damage all physician-patient relationships. If you're on Twitter, you'll see what I mean if you read the responses to Moore's tweet.
Medical ethics and dating a patient
But what about a "mutually consensual" relationship between a doctor and a patient? When answering the question of whether it's ever OK to date a patient — current or former — or a patient's family member or caregiver, it's best to first ask exactly what dating is.
Fundamentally, dating is a way for two equals to explore potential romantic or sexual interest. After doing so, they may go their separate ways or they may decide to forge a new — perhaps even a lasting — relationship. In order for the term "dating" to legitimately apply, however, it is key that the two parties be on equal footing. If they are not, then the term "dating" is misapplied.
As a rule, society rejects sexual interactions as immoral, or even criminal, when one party has significant power over the other. These interactions, even if they are only verbal or implied, constitute a functional violation of the more vulnerable party and frequently cause significant psychological harm. It is on these grounds that we consider it a crime for adults to engage in sexual acts with minors or in any way use them for sexual gratification.
Despite the current trend of viewing patients as equal partners in the decision-making process, the physician-patient relationship is inherently one of unequal power and always will be. The patient comes to the physician precisely because they have something, be it knowledge, skill or experience, that the patient needs. Even if my patient or their caregiver is more knowledgeable than I am, their circumstance makes them vulnerable while mine lends authority in the context of patient care.
The same goes for clergy, lawyers, educators, managers and employers. Where one party has power that the other lacks, be that religious authority, the power to affect the other's destiny through legal protection, grades, recommendations, salary or promotion, there is no potential for an ethical romantic or sexual relationship.
This notion is not new. If you read his original oath, you will see that even Hippocrates espoused this view, writing, "Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men." He recognizes the vulnerability of those seeking care and the temptation to turn their adulation or desperation into fuel for sexual or romantic interaction. Even 2,400 years ago, he called it "a voluntary act of impropriety (and) corruption," making it clear that no such interaction can be truly consensual.
How medical licensing boards see it
State medical licensing boards, which are charged with the protection of the public, take Hippocrates' side. In their statement "Addressing Sexual Boundaries: Guidelines for State Medical Boards," the Federation of State Medical Boards (FSMB) condemns both sexual violation and impropriety, including "behavior, gestures, or expressions that are seductive, sexually suggestive, disrespectful of patient privacy, or sexually demeaning to a patient." If you compare the scenarios they describe to Lane Moore's Twitter conversation, you'll find her respondents describe exactly the sorts of scenarios the FSMB proscribes. All those behaviors constitute grounds for disciplinary action against a physician's license.
When patients come to us with their pain, illness and fear, prepared for us to interact with their physical being in a way no other stranger would, they place a sacred trust in us. We owe it to them to maintain clear boundaries around our sexual and romantic impulses, reserving those for situations and people who are well removed from our professional lives.