Former patient dating
Only in very particular circumstances could such relationships be ethically permissible.
the deleterious effects of such relationships upon patients have become increasingly recognized and condemned by the medical community. One such area is whether sexual relationships with patients are ever ethically permissible and, if so, under what circumstances.
Nor is love in the supermarket based upon a fiduciary relationship (see later discussion).
In addition, ‘love transference' can be extremely capricious, often hiding a destructive hate transference that frighteningly erupts and engulfs the therapist and patient.
Doctors can mistake the feelings of love that arise in a therapeutic relationship as being the same as love that arises elsewhere; it is not.
‘Love in the supermarket', as opposed to ‘love transference', is based more in reality and not propelled to an artificial intensity by an unequal power structure.
This is recognized within professional codes, for example by the New Zealand Medical Council which states that “the ethical doctor– patient relationship depends upon the doctor creating an environment of mutual respect and trust in which the patient can have confidence and safety”. It is an underlying principle of the concept of boundaries and it has been argued that it is the doctor's breach of fiduciary trust, not the patient's consent, which is the central issue regarding sexual misconduct. After 6 weeks in hospital, on the day of his planned discharge, he was accidentally given another patient's medication.
This suggests that the overwhelming outcome for most, if not all, patients is negative. the specific impact of a particular boundary crossing can only be assessed by careful attention to clinical context”., the analysis has to examine other factors.
Sexual misconduct usually commences with violations of more minor boundaries:“The road to therapist–patient sex is paved with progressive boundary violations.
Except when a patient is raped, the therapist who eventually sexually abuses a patient follows a remarkably predictable ‘natural history' of sexual misconduct.” Not all stages will take place in any one relationship, but the general stages include: gradual erosion of therapist neutrality; socialization of therapy; the patient is treated as ‘special'; doctor's self-disclosures begin; physical contact begins (e.g.
Doctors are more vulnerable to counter-transference when the doctor unconsciously or subconsciously overidentifies with the patient's situation, so much so that one author comments:“The power of the subconsciously driven countertransference to create rationalisations that the sexual relationship with the patient is ‘special and the exception' to the usual rules of professional conduct should never be underestimated.” Such ‘overidentifiers' are often ‘situational reactors' who are responding to particular triggers such as marital discord, loss of important relationships and a professional crisis in their own lives.
Whilst situational reactors are certainly an at-risk group, unlike other categories of doctors who offend (e.g.
However, the crossing of boundaries does not necessarily mean that an unethical act occurred: after all, the crossing or erosion of boundaries is a normal part of the evolution of intimate relationships between human beings. Clues as to what these other factors should be can be gleaned from examining the profiles of offending doctors.