Doctor dating a patient ethics
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.First, the concepts of boundaries and transference are discussed and a profile of the medical practitioner at risk of offending is drawn.Secondly, three aspects of the doctor–patient relationship are explored: the general characteristics which promote health care; the importance of trust and the fiduciary relationship; and the role of power and authority in the relationship.In turn, to build such a relationship, the unequal power distribution between doctor and patient has to be acknowledged and contained in an ethically correct manner. As attempts were made to rapidly infuse intravenous fluids and rescue his remaining renal function, the specialist cried ‘I realized that they were the wrong pills but !The onus of responsibility for this last task falls on the person who has the most power in the relationship which, as I will argue, is always the doctor. the power that a physician possesses by virtue of her training in the discipline and the art or craft of medicine”. ' Despite having the Aesculapian power of a doctor, and the Social power of a hospital specialist, in addition to considerable Charismatic power (he was a well-liked and respected colleague), none of these were sufficient to counteract his lack of Hierarchical power by being a patient.
In his book Brody outlines three sources of medical power: Aesculapian, Charismatic and Social. (This applies in both general practice and hospital-based medicine, although it may be accentuated by the latter's institutional culture.
Transferences of transference, linked with the fiduciary relationship and unequal power structure, which makes most relationships with former patients ethically unacceptable (see following sections). [the] special confidence reposed in one who in equity and good conscience is bound to act in good faith and with due regard to the interests of one reposing the confidence”. It has also been suggested that another source of power —Hierarchical power, the power inherent by one's position in a medical hierarchy (e.g. To help understand these four types of power, and the relationships between each type, consider the following incident from my personal experience as a first year house surgeon in Australia in the mid-1980s.
It is important in the doctor–patient relationship that a ‘neutral, safe space' is established which allows a therapeutic alliance to grow. Three salient features describe the circumstances in which this type of relationship occurs: there is an expectation of trustworthiness, an unequal power relationship exists and the interaction occurs under conditions of privacy. Although it does not involve the sexualization of the doctor–patient relationship, it clearly illustrates the importance of recognizing all four types of power, and, in particular, the prominence of Hierarchical power: A consultant specialist was admitted to hospital with a severe multi-system disease causing severe renal impairment.
This does not mean that no such type of relationship may exist, but it has not been researched.
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.
hugs, kissing); extratherapeutic contacts occur; dating begins; sexual intercourse occurs.