Heart Blocked

Screenshot 2014-07-31 16.55.11

In this article, second year Robyn Perry-Thomas takes a tentative look at the foggy world of personal doctor-patient relationships, social media complications and other matters of the heart which are not covered in ‘ECG Made Easy’…

Your eyes lock over the crowded room, for once everything has turned still. Even the bleeping of the machines seems to have dulled a little (not completely, this is Accident and Emergency after all). It is the moment you have always waited for- a truepopcorn popping moment. There’s only one problem; you’re wearing a stethoscope, and they are your patient. As numerous lawsuits have shown, it would seem that there is a fine (IV) line between love and legislation. Well, before you get your cannulas in a twist, let’s have a look at what would happen if a doctor unwittingly gives a love prescription…

We all know that finding ‘The One’ can be difficult, especially if you’re working in a profession that is highly stressful, consists of long working hours and involves life-or-death decisions on a day-to-day basis. But this is not an excuse to start using the names on your handover sheet as your personal Dating Direct best matches summary. The GMC state in their guidance ‘Good Medical Practice’ “You must not use your professional relationship to establish or pursue a sexual or improper relationship with a patient or someone close to them”. At first glance that all seems pretty clear and the reasoning behind this is sound.[1]

Patient trust is of upmost importance in all doctor-patient relationships. Engaging in a personal or otherwise inappropriate social relationship can quickly lead to imbalances in trust or even loss of patient trust completely.

This could be experienced either by the patient themselves, or other members of public who are made aware of the relationship. This goes directly against the ‘Duties of a Doctor’ to never abuse the public’s trust in the profession. Onlookers may see this relationship as sign of a doctor giving a certain patient preferential treatment; patients themselves may worry that their treatment (or that of a loved one) will be negatively compromised should they end the relationship and the air of professionalism, to some degree, will be inextricably lost.[2]

 Additionally, it is key to remember that patients are by default a vulnerable population, at least to so
me extent. Their cognitive reason and approach to  personal relationships may well be different from when they are at their own optimum health (think beer goggles, but with stethoscopes instead). To embark on a bedside romance therefore, could be to take advantage of an already compromised individual.

Fair enough, this conclusion may seem a little far fetched if the patient in question is being treated for a rapid and easily reversible condition such as a penny lodged in their nose, which is unlikely to cause significant emotional shifts for a patient (although rooting through the nasal cavities is yet to strike me as a particularly romantic endeavour). However, if a patient is being treated over a longer time with a more serious condition, then the vulnerability of the patient and, subsequently, the compromise of their reasoning must be kept at the forefront of any clinicians mind.

Embarking on a personal relationship with a patient under your care is always going to be met with the highest degree of scrutiny. One of the first things that we as medical students have been taught is not to take a decision from a patient unless they are able to give informed consent. A consent form that says ‘Treatment X is most likely to end in heartbreak, regret and a night month, spent re-watching Dirty Dancing over box after box of Milk Tray’ is hardly likely to be signed with eager anticipation.

Still, for the romantics at heart, the idea that true love will always be contraindicated in a doctors office does not sit well and there  are, of course, complications and exceptions to the picture. What if the patient is no longer under your care? What if the professional relationship ended several years ago? These questions are less easy to answer with a blanket ‘yes/no’ response, and this is recognised by the GMC who have further guidance in their Maintaining Boundaries guidelines. In these more complex situations, what becomes appropriate is difficult to judge, meaning that relevant, specific and tailored advice is required (which is this author’s way of saying that I am not jumping into that Pandora’s box in this article…).

Tweet them mean…

What happens however, if you find yourself unintentionally on the other end of the amorous advances of a patient to whom you have no desire to begin a relationship with at all? In pre- Zuckerberg days, a persistent patient could arguably be handled more easily. They could, for instance, be gently rebuffed face-to-face with a kind word (or beefy security guard or two if that wasn’t successful). However with the birth of Facebook and subsequent explosion of social media, avoiding love-struck individuals may not be quite as easy. After all, unlimited, free and traceable emails and Facebook messages are a lot harder to avoid, thereby making them much more aggressive to be on the receiving end of, than a penned letter sent by snail mail (especially given the tendency of unwanted letters to be “lost” in the post).

Such diagnoses of unrequited love are not merely theoretical; in  fact they are on the rise. In 2007-2011, the Medical Defence Union (MDU) received appeals for advice from 100 cases of doctors on the receiving end of unwanted advances. This is an increase by around a third of the previous 4 years. These cases range from what one may consider to be, admittedly uncalled for, flattery to downright harassment and stalking- putting doctors in very uncomfortable situations. Two such recent cases have become widely used as examples to enlighten doctors and the public alike. In the first of these cases, an enamoured patient whose previous advances had been rejected, sent a bunch of lilies to their doctor having discovered that these were her favourite flowers via her Facebook page.[3]

In the second example, unrequited love took a more sinister turn. A patient who was suffering from some form of mental illness had repeatedly made inappropriate advances towards her family doctor, including sending multiple Facebook friend requests. The doctor transferred the care of the patient to another doctor within the practice, however his troubles were far from over as the patient subsequently made accusations of an inappropriate sexual relationship with the initial doctor. The doctor was cleared of all charges, but only after a 6- month investigation and the undue stress this would have caused cannot be underestimated.

Preventative practice

To some extent an affectionate patient response is natural and even encouraged. After all, in order to get the best outcome from a doctor-patient encounter (especially that all important patient history) you want your patient to feel comfortable enough around you so that they can open up and talk freely about a wide range of personal and intimate issues. In an article from Pulse Magazine a patient suffering from a rare cancer beautifully describes how ‘falling in love with her oncologist’ was something that helped keep her going over the weeks following her treatment. It may be useful to add that the doctor was unaware of the love affair taking place, and the patient recognised its natural end as her condition improved.[4]

The seed of the problem therefore may be found in a strong doctor-patient relationship. For what a doctor may view as being good communication skills (and following the Calgary- Cambridge Method to the letter) a patient may interpret as something, well, more. As previously touched upon, this may be especially true of chronic conditions where the lines between attentiveness and affection may become blurred beyond recognition.

So, what can you do? Well, before you start drawing on zits, drinking copious quantities of  garlic tea, and donning those fluorescent yellow crocs, there are some steps that you can take in order to reduce the opportunity for such advances in the future. These are obvious and simple suggestions such as ramping up your privacy settings on Facebook, using a pseudonym on twitter and anonymising any posts that you make which are available online.

It is key to remember, that your role as a member of a medical team is to care for the whole of your patient, which includes matters of the heart that are not apparent on the ECG, and so sensitivity and caution should be a natural part of your day to day practice. Still, if you’re really concerned, perhaps you should keep that tea on the boil just in case…

REFERENCES

1. GMC: Maintaining Boundaries [Online] Available at < http:// www.gmc uk.org/guidance/ ethical_guidance/maintaining_boundaries.asp> [Accessed 28th December 2012]

2. GMC: Duties of a doctor [Online] Available at < http://www.gmcuk.org/guidance/good_medical_practice/ duties_of_a_doctor.asp&gt; [Accessed 28th December 2012]

3. Two examples of MDU cases [Online] Available at < http:// www.guardian.co.uk/society/2012/oct/28/lovesick-patients-stalkdoctors-online&gt; [Accessed 28thDecember 2012]

4. Pulse Magazine article: Falling In Love With My Doctor [Online] <http://pulsemagazine.org/Archive_Index.cfm?  content_id=142> [Accessed 31stDecember 2012]

5. Image: [Online] Available at: <http:// lymphomajourney.wordpress.com/ 2012/11/22/love-a-word-thatmedicine-fears/&gt; [Accessed 17thJanuary 2012]

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s