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August 2013
The lesson for fledgling doctors comes early in medical school: Getting romantically involved with a patient is forbidden. Verboten. A definite “don’t” in any physician’s playbook.
The problem is that not every patient plays by the rules, and a patient prone to flirtation can create a dicey ethical dilemma for a doctor—or at least make office visits uncomfortable for physicians and staff.
While physicians vary in their approaches to managing flirtatious patients, many agree that nipping the behavior in the bud is critical to maintaining professionalism and upholding ethical standards. “It’s flattering to have a flirtatious patient,” said Kenneth W. Altman, MD, PhD, director of the Eugen Grabscheid MD Voice Center and associate professor of otolaryngology at the Icahn School of Medicine, both at Mount Sinai Hospital in New York City. “But, we have an obligation to protect the integrity of our profession, and to our marital contracts, to act professionally at all times.”
Dr. Altman finds it helpful to put some professional distance between himself and a flirtatious patient. “I have no problem saying to a patient: I appreciate what interests you may have, but I have to draw the line to take proper professional care of you,” he said.
Laura T. Hetzler, MD, a facial plastic and reconstructive surgeon at Our Lady of the Lake Regional Medical Center in Baton Rouge, La., and assistant professor in the department of otolaryngology at Louisiana State University School of Medicine in New Orleans, said she derails flirtatious behavior from patients by deflecting their unwelcome comments. “I’ve learned not to act sheepish about it,” said Dr. Hetzler, who has had patients who weren’t shy about commenting on her clothes, shoes, figure or recent weight loss after pregnancy. When a patient’s remark crosses the line from complimentary to something uncomfortable, she either curtly laughs it off or ignores it. “I don’t acknowledge the statement and immediately move the conversation into something clinical,” Dr. Hetzler said. “That puts the rest of the visit in a serious tone.”
Take a Team Approach
Dr. Hetzler also instructs her nurses to have another staffer accompany them into an exam room when a patient known for being flirtatious is waiting to be seen, and to leave the door open. Dr. Hetzler said she also brings a nurse with her during an exam with that type of patient.
Likewise, other physicians use a “more is merrier” approach for themselves and their staff as a defense against flirtatious behavior. “It is a problem we avoid by having our physicians never see patients alone,” said Robert Sataloff, MD, DMA, FACS, professor and chairman of the department of otolaryngology–head and neck surgery, senior associate dean for clinical academic specialties at Drexel University College of Medicine in Philadelphia and a physician with Philadelphia Ear, Nose and Throat Associates. “There is always a nurse or medical assistant [in the room with the physician], even if we have to see somebody in the office on call after hours,” he said. “We have a call schedule for the nursing and medical assistant staff. And that includes patients of both genders, regardless of gender of physician, since flirtatious behavior can be same-sex flirtatious behavior.”
Robert H. Maisel, MD, a professor of otolaryngology–head and neck surgery at the University of Minnesota in Minneapolis, said that while he has never recognized a problem with a flirtatious patient in his clinical practice, he rarely has a clinical encounter without a medical student, surgical resident or nurse in the room during the examination.
Recognize the Signs
While it’s important that physicians don’t act on a flirtatious patient’s advances, it’s equally critical to recognize subtle flirtatious signs from a patient. A patient who maintains unusually long eye contact with their doctor, engages in a lot of talk not related to their visit or makes a habit of touching the physicians when not medically necessary may be flirting.
Additionally, otolaryngologists can protect themselves when performing some common procedures, such as flexible laryngoscopy or nasal endoscopy, both of which put the physician in close proximity to a patient’s face. That closeness could turn a clinical exam into a flirtatious event, said Dr. Altman. He wears a mask to perform each of these procedures, and not only for the purposes of infection control. “It does give you the added benefit of establishing some personal space and protection, to avoid any potential misunderstanding,” he said. Dr. Altman said he also listens to patients’ lungs through their shirts, not underneath their shirts, and calls an assistant into the room with him before he does that type of exam on a young woman.
“I don’t acknowledge the statement and immediately move the conversation into something clinical.”
—Laura T. Hetzler, MD
Potential Outcomes of Flirtatious Behavior
Although flirting may seem innocent in most situations, it can have serious consequences if it persists and escalates between a physician and patient, particularly if the physician becomes sexually involved with that patient.
For starters, physicians who become romantically involved with patients may lose sight of their professional obligation to be objective in treating them, said David Fleming, MD, chairman of the department of internal medicine at the University of Missouri, director of the university’s Center for Health Ethics, both in Columbia, and a physician specializing in internal medicine. “When you’re biased in your decision making, or so emotionally attached to a patient that you can no longer be objective, then you’re no longer on your game, and you’re no longer able to provide the best quality of response that the patient deserves,” Dr. Fleming said.
Additionally, a physician may be the target of a civil lawsuit by a patient when the relationship comes to an end. Using the defense that the relationship was consensual is typically not a strong one, given societal views that physicians are in the power position when it comes to initiating, or ending, a physician-patient relationship.
If a physician is found to have engaged in sexual misconduct with a patient, he or she may be sanctioned by a state medical board, which can dole out any number of punishments, not limited to censuring the physician privately or publicly or revoking his or her license to practice medicine, said Steven M. Harris, Esq., a health care attorney with the law firm McDonald Hopkins, LLC in Chicago and author of the “Legal Matters” column in ENTtoday.
Harris advises physicians to tell patients, in no uncertain terms, that flirtatious behavior isn’t welcome. “It’s very clear that a physician cannot engage in flirtatious activity with a patient. If the activity continues on, the physician has no option but to terminate the relationship,” he added. “I would follow up a termination in writing and tell the patient: You may seek a physician of your choice, or, if you need a recommendation, we are happy to provide you [with] three names.”