The ethical line between patient and physician

DEAR DR. ROACH: Recently, a physician in my area lost his license for having an intimate relationship with several of his patients. I’m just curious why this is considered so unethical if both parties are adults who are sound of mind. Are physicians not allowed to have relationships with patients outside of their practice? If I want to see my physician for personal reasons and not medical ones, should I find a different provider first? -- N.E.

ANSWER: The reason it is unethical for physicians to have intimate relationships with their own patients is that they are in a position of trust and responsibility, so any sexual relationship with a patient is misconduct. For former patients, the ethical boundary is blurred; it depends on the type of relationship that the physician had. If you saw someone in the emergency room who ordered an ankle X-ray, that’s a very different situation from one in which there was an ongoing therapeutic relationship. In the first case, a relationship may not be inappropriate, but in the second one, I feel a relationship is never appropriate: There is too much potential for the physician to exploit the trust that derives from the patient-physician relationship. A smaller but significant consideration is that physicians who treat people they are emotionally close to have difficulty being objective as physicians.

Experienced therapists recognize the issue of transference: a patient (or client) develops romantic feelings for the therapist, whose professional role is to be a careful and attentive listener as well as try to use his or her expertise to help the patient. It is not uncommon, and is part of the goal of some types of psychotherapy. However, the patient is not seeing the therapist as a person, but as an ideal. Thus, development of strong positive feelings is understandable.