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Doctor Patient Relationship Boundaries

Where do you draw the line when it comes to romantic or sexual relationships with patients or a family member of a patient?

As a health care provider you are in a unique position—patients may share confidential information with you, creating for them a sense of intimacy. When you pay attention to them, or give them comfort by addressing their physical concerns, they can misinterpret your care. Before you reciprocate those feelings, remember you are in a position of trust, power and authority so it is of primary importance that provider-patient relationships are structured in the context of health care with established professional boundaries.

Codes of Ethics

Most professional codes of ethics related to health care include some sort of statement regarding relationships (romantic and/or sexual) between the health care provider and their patients. There is good reason for these codes, as initiating or maintaining a relationship while the patient is undergoing treatment could have far-reaching consequences. Even a suspicion or allegation of a boundary violation can initiate an investigation by an employer or professional board. For example, a relationship with a current patient could lead to allegations of undue influence, exploitation and compromising of clinical judgement.

It also makes no difference if the patient appears to consent to or initiate the relationship. Even a relationship with a family member of a patient may be construed as having influence on the health and welfare of the patient.

"Cooling Off" Periods

Some professional boards have what they call “cooling off” periods. These refer to waiting at least one year after formally ending the provider-patient relationship before initiating a romantic relationship. However, relationships with former patients need to be considered as potentially risky if it may appear to an investigative board that the provider’s knowledge from their professional relationship could be determined to have been used to exploit the individual. Much can depend on the length of the provider-patient relationship and the context of that professional relationship prior to the “cooling off” period. Some specialty associations believe there is no “cooling off” period and there should never be a relationship with a former patient.

In your practice, where do you draw the line when it comes to romantic or sexual relationships with patients, or a family member of a patient? And is that line only for the primary provider, or does it extend to staff? Does your staff know and understand your policies?

It is best to have a policy which applies to all staff when it comes to relationships with patients and/or patient family members. Of course there can always be extenuating circumstances, so seek guidance from an impartial third party such as your professional society or attorney if you have questions or concerns about boundaries.

Your Malpractice Insurance Policy

Be aware that some malpractice policies exclude or have reduced coverage available for “sexual impropriety, sexual assault, sexual harassment, or any other similarly defined act," so if these types of allegations would arise from a relationship, you could be on your own or with limited coverage when defending your actions.

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