Doctor/Patient Relationship
BEGINNING AND ENDING THE RELATIONSHIP
The relationship between a doctor and his patient is a voluntary relationship that is to be
entered freely on both sides. In the same way that you cannot compel a patient to accept a
particular doctor as her physician without her agreement, a physician cannot be compelled to
accept a patient without his agreement A doctor must agree to accept a patient. There is no
obligation on the part of the physician to accept a patient. This is true no matter what need
the patient has and whatever expertise the doctor may possess.
For example, a patient with diabetes lives in a small town with only one
endocrinologist. The endocrinologist has a full practice and is not accepting new
patients. The patient has very bad diabetes and has a very complex regimen that her
family practitioner insists is beyond the scope of his understanding. The patient shows
up in the office and insists to the office manager that she be accepted. What should be
done?
The physician is under no legal obligation to accept the patient. There is considerable
misunderstanding of this issue. The physician, by training and inclination, is geared to aid the
suffering. However, there is still no mandate for the physician to accept the patient nor can a
patient force a physician to take care of her. Even Good Samaritan law, which protects
caregivers from liability if they aid a sick person in the street, does not force the doctor to aid
an injured person. You may feel a moral obligation to help everyone, but there is no legal
obligation to enter into a doctor/patient relationship. This is different from a hospital’s
mandate to provide emergency treatment to anyone who comes to the emergency department.
Hospitals cannot turn anyone away at the door of their emergency room if they come seeking
care. This does not mean they must provide continuous care after discharge, but it does mean
there is a national legal mandate for all hospitals to provide emergency management and
treatment of all patients.
Once a patient and physician have entered into a care relationship there is far greater
complexity in ending that, relationship. A physician cannot suddenly end the relationship. He
must maintain the care of the patient until the patient can find an appropriate alternate source
of care and he must give “reasonable notice”.
GIFTS FROM PATIENTS
Small gifts from patients of nominal or modest value are acceptable on the part of the
physician. This is provided that there is no expectation of a different form of therapy or a
higher level of care based on the gift. You can accept a cake at Christmas, a balloon on your
birthday, or other tokens of esteem, but not if the patient expects an extra, or different
prescription for something, in exchange for the gift.
The rules on gifts from patients are far less rigorous, precise, or clear than the rules on
gifts from the pharmaceutical industry. There is an automatic presumption that gifts from
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industry always carry an influence toward a product, service, or prescribing practice. Gifts
from industry are viewed differently because there can be no other intention behind them
except to buy influence and alter behavior. There is no such automatic presumption on the
part, of gifts received from patients.
DOCTOR/PATIENT SEXUAL CONTACT
Sexual contact between a physician and a patient is always inappropriate. It is unclear if
there can ever be a completely acceptable, ethical way to alter the physician/patient
relationship so that sexual contact is acceptable. At the very least, the physician and patient
must mutually agree to end the formal professional relationship of a doctor and a patient. It is
not clear how much time must elapse between the ending of the professional doctor/ patient
relationship and the beginning of a personal relationship. The recommendation for
psychiatrists is somewhat unique. The American Psychiatric Association guidelines
specifically state that there can never be a sexual or personally intimate private relationship
between doctor and patient even after the professional relationship has ended. In other words,
a psychiatrist should not have sexual contact even with former patients.
These guidelines apply no matter who initiates the relationship. In other words, it is not
more acceptable for a doctor and patient to have sexual relations if the patient initiates the
sexual relationship rather than the physician. These guidelines also take no account of gender
or sexual orientation. It is always ethically unacceptable to have a sexual relationship
between a psychiatrist and either a current or a former patient. It is ethically unacceptable for
a physician of any kind to have a sexual relationship with a current patient.