But isn't such a take on the doctor-patient relationship out of date, even paternalistic? Online resources have reduced the information gap between doctors and patients, patient autonomy is greater than ever before, and not everyone who walks through a consulting room door is a shrinking violet. Some doctors feel that the shoe is now firmly on the other foot. The classic paradigm, with the single handed usually male practitioner exploiting vulnerable female patients is less likely today because doctors work in multidisciplinary teams, where such behaviour would be exposed.
It is also easy to think of examples that verge on the absurd; should junior doctors treating fellow medics in accident and emergency be forever precluded from dating them? As the patient as consumer comes of age, and the power and status of professionals wanes, is Graeme Catto right or is the doctor-patient relationship now a meeting of equals?
As with so many questions that arise in ethics, the honest answer must be, it depends. Recent history is sadly strewn with sobering examples of doctors abusing their power—Rodney Ledward, Harold Shipman, Peter Green. If so many doctors had not abused their power in the past, calls for restraint would not be as loud. Irrespective of the pressure that the softening of traditional hierarchies of authority is bringing to bear, the doctor-patient relationship remains a kind of exemplar.
Patients are often vulnerable when they visit doctors. They can be sick, distressed, and disorientated, even if they express their need in an aggressive or overconfident way. Patients may need to reveal the most private information. Without the expectation that boundaries will be observed and trust respected, they may be less forthcoming, and patient care will suffer. Information trawled from the internet will never be a substitute for informed professional judgment.
It is for the interpretation of such information as much as for its provision that we rely on professionals. So it is a special kind of relationship, rooted in trust as much as contract, governed by professional boundaries that protect doctors as well as patients, and subject in complex ways to the ebb and flow of power. The GMC has a difficult job to do. In falling short of a blanket ban, in recognising that there will always be exceptions, it has made a wise choice.
A patient may well have a closer, more dependent relationship with her auto mechanic than with the dermatologist she once visited to have a plantar wart removed. Similarly, a patient may not even remember the anesthesiologist who presided over his gallbladder surgery or the emergency department doctor who once stitched his finger. Ethicists say the distinction is valid.
Some specialities by their very nature create a more intimate relationship, and one that makes the patient more vulnerable. Recognizing that, the American Psychiatric Association categorically prohibits sexual relationships with either current or former patients. Is 6 Months Too Soon Before Dating a Patient? Does a coincidental meeting at a cocktail party where you engage in a personal conversation constitute the beginning of a relationship? What if you attend the same church?
Play in the same tennis league? Have children in the same school? Many such relationships simply atrophy with inattention. But is the relationship over?
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Green light for doctors to date former patients so long as they use their 'professional judgement' to decide if it is appropriate
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