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How Close Should We Be To Our Patients?
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Here’s a short patient vignette for your consideration. I recently did surgery on a patient whom I have been treating for some time. A couple of weeks before the surgery, my patient invited my family over for dinner. I didn’t say anything at the time, not wanting to decline outright (I was hoping the issue would go away on its own). Unfortunately, a couple of weeks later, when the patient asked again, I had to explain that my university has a policy against doctor-patient fraternization. He very kindly understood the situation, but I felt a little guilty. This patient became fond of me as his doctor and desired to expand the relationship.
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I had to maintain the distance because of current company policy, but I have violated this type of policy previously (at a prior job). For example, when I practiced in Oregon, I had a diabetic patient with whom I’d worked to save her leg for a year. At the end of that year, she unfortunately had to undergo a below knee amputation. However, as a very positive part of our relationship, I invited her and my medical assistant (who had been highly involved in her care) to dinner to celebrate the day she was fully weight-bearing again with her prosthetic. We had a very nice dinner, and looking back on the entire experience, this was a nice – even integral – part of the entire process, providing closure for both my patient and her caregivers.
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Obviously there is a spectrum to the relationships healthcare providers have with their patients and staff. On the one hand, it is absolutely prohibited and unethical for medical providers to have intimate physical relationships with their patients. I did experience this one. Years ago, a female patient actually made a pass at me, asking if I wanted to have a sexual relationship. I politely declined, trying to redirect our encounter back to her foot issue. I then almost laughed in her face when she mentioned her boyfriend was in the waiting room! Unbelievable!
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On the other end of the spectrum is to be completely impersonal and robotic with patients. It is obvious that physicians need to have a certain level of personal connection with our patients. We are human beings working to help other human beings, and without an emotional connection, we cannot adequately treat those who need our help with any sense of humanism.
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Somewhere in the middle is where the challenge arises. Take small gifts, for example. I have a patient whose wife often brings in sweets and food gifts for the staff and me. This is a very nice couple that I genuinely like, and I would never turn down these small gifts. The wife takes the time and effort in several cases to hand make the food. How insulting would it be to turn that down? Besides, the food is absolutely delicious!
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One might argue that these gifts imply some “in kind” reciprocity, such as waiving a copay or giving a free service of some type. I can honestly say that in almost 10 years of active clinical practice, I have never been propositioned in this way. No one has ever asked me to perform this type of quid pro quo service. It seems pretty dumb to do so nowadays, since insurance pays for most of our patients’ medical costs. This isn’t the old days where patients paid for their doctor’s services with chickens or cash.
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Luckily there’s no Sunshine Act for our patients (yet). When it comes to the extremes of the spectrum, it’s obvious for most healthcare providers: don’t sleep with your patients, and don’t be an uncaring machine. For everything in the middle, each of us has to follow our own individual sense of ethics (as well as following our company’s human resources policies). So, unless I’m told otherwise, I’ll keep accepting those patients’ brownies and chocolates.
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*Approved for 16 CME/CECH Credit Hours
This activity has been planned and implemented in accordance with the standards and requirements for approval of providers of continuing education in podiatric medicine through a joint provider agreement between the New York College of Podiatric Medicine and PRESENT e-Learning Systems.
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