The Physician-Patient Relationship

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The Physician-Patient Relationship
Tahira Duncan
Drexel University

Abstract

Sexual contact that occurs concurrent with the patient-physician relationship is considered to be sexual misconduct. The Hippocratic Oath prohibits such relationships. The Oath is deeply rooted in first do no harm. By violating beyond the boundaries in a patient-physician relationship it cause harm to the patient.

Boundaries: The limits of appropriate behavior by a professional toward his/her client. Transference: Of which a patient is usually unaware and/lacking insight into its significance. Undue Influence: A judicially created defense to transactions that have been imposed upon weak and vulnerable persons that allows the transactions to be set aside.

The Physician-Patient Relationship

The patient-physician relationship entails special obligations for the physician to serve the patient’s interest because of the special knowledge that the physician hold and the imbalance of power between physicians and patients (ACP, 1998). Patients should be able to trust that their interests and welfare will be placed above those of the healthcare provider, just as they should be confident they will be treated with respect, and be informed so that they can make their own health care decisions to the greatest extent possible (NEC, 2003). As the American College of Physicians Ethics Manual notes, physicians’ obligations to society “parallel their obligations to individual patients (NEC, 2003). Physicians’ conduct as professionals … should merit the respect of the community” (ACP, 1998).

Limits of appropriate behavior by a professional towards his or her clients are known as boundaries (NEC, 2003). Boundaries, it has been said, “define the professional relationship as fundamentally respectful and protective of the patient and as dedicated to the patient’s well-being and best interest (Robers,Battaglia and Epstein, 1999). Code of Ethics and other standards define the boundaries of appropriate behavior for health care providers. The Medical Professionalism Project of the American Board of Internal Medicine notes, for example, that medical professionals must exhibit a: Commitment to maintaining appropriate relations with patients. Given the inherent vulnerability and dependency of patients, certain relationships between physicians and patients must be avoided. In particular, physicians should never exploit patients for any sexual advantage, personal financial gain, or other private purposes (Med., 2002).

A variety of standards establish the limits of appropriate professional behavior, whether those limits are explicitly enumerated in standards of conduct, codes of ethics, or law, or tacitly conveyed through professional training and widespread acceptance. Individuals who seek help must rely on the professional they consult to be trustworthy: When practitioners behave in ways that call their professional judgment and objectivity into question, the trust on which the relationship depends is compromised. And when trust is compromised, the efficacy of the therapeutic relationship is adversely affected (Mechanic, 1998).

Boundary violations harm not only individual patients, they carry consequences for others when they erode trust and confidence in the profession more broadly. Practitioners’ obligations to society parallel their obligations to individual clients. Practitioners’ conduct as professionals should merit the respect of the community (ACP, 2003). Clear and scrupulously adhered to boundaries thus protect health care professionals as well as clients, helping to sustain the public trust on which the freedom to practice rests (NEC, 1998).

One of the most common boundary violations is sexual misconduct. Sexual misconduct in the patient-physician relationships have also risen within the last ten years. The code of ethics for all medical and surgical specialties defines sexual relationships between doctors...