New rules proposed to limit doctor-patient relationships
Doctors should avoid financial, legal and other “close personal” relationships with patients, the College of Physicians and Surgeons of Alberta says in a set of proposed rule changes for the profession.
While sexual interactions between doctors and patients are already banned, the college is now seeking to broaden its regulations on so-called “boundary violations” to include other types of relationships that similarly risk creating a conflict of interest.
“As an example, if you have been close friends with somebody for many years, then having a physician-patient relationship on the side may somehow interfere with that trust relationship,” assistant registrar Dr. Jeremy Beach said in a recent interview.
“The concern would be that it would compromise the professional side.”
Beach acknowledged the proposed changes have been controversial in some circles, particularly among rural physicians for whom personal or business relationships with patients may be unavoidable.
Feedback posted on the college’s website has questioned whether the amendments would allow rural doctors to hire the town accountant or shop at the lone grocery store if a patient relationship already exists.
“It may become extremely difficult for doctors to see patients in small communities . . . without then walling themselves off from the rest of the community, resulting in isolation,” one commenter wrote.
“This could have the unintended consequence of making it even more difficult to retain doctors in rural areas.”
Beach said the proposed amendments were written in a deliberately broad way, in part due to the difficulty of crafting a precise definition that would cover all potentially problematic scenarios.
He said the college has no desire to see physicians cut themselves off from personal relationships, since it’s essential to good care that doctors display a “human facet.”
He said the intent is to prompt doctors to think about the wisdom of getting into a certain type of additional relationship with an existing patient.
As an example, a physician treating the local manager of bank where the doctor has an account likely isn’t problematic.
But a doctor who asks for a loan might make that patient feel coerced into accepting.
Other cases may be more difficult to gauge.
The scenario of a physician who accepts a discount from a baker on her weekly bread order may seem harmless, but it might also be enough to change how the doctor handles the baker’s care.
It might also create a perception in the community that the baker is receiving preferential treatment, Beach said.
Some experts in medical ethics have warned that doctors who have secondary interests in their patients often tend to alter their standard of care — perhaps by granting a questionable prescription or making a premature diagnosis.
“As long as a physician is mindful of it, they will prevent most of it from happening,” Beach said.
“The cases that end up with the college (as a formal complaint) would be the most serious, complex ones.”
He said other physician colleges, such as those in B.C. and Ontario, have adopted or are exploring similar rules.
The Alberta college is currently considering further revisions, after which the college’s council could vote to approve the regulations in March or June.