After consulting a patient for a common flu treatment, in any normal circumstance, the meeting should end there and then. But what if, the patient still approaches the doctor personally – giving gifts, contacting through phone calls, messages and social media to show affection – despite stern rejections and warnings?

This may be another eerie fiction of a psycho stalker, but for several healthcare professionals (HCPs), it is reality. Even worse, the increased popularity of social media has made it easier for patients to continue their act of delusion.

As discussed in our previous article, while HCPs know that forming romantic relationships with patients are frowned upon – this may not be the case with patients. They may not understand the boundaries of a professional relationship, or the law that the HCPs are bound to. In this second half of the discussion, we speak to a few guest experts – as they share their professional insights into this topic.

First, understand the underlying problem

To curb such problems, rather than having a knee-jerk reaction of filing a lawsuit, Mr P.S. Ranjan, Partner at P.S. Ranjan & Co., suggests “investigating the root of the cause”.

Patients may have inappropriate feelings or delusions due to their vulnerability and medical conditions, hence giving them a false perception.

“Doctors have the advantage to understand better, and that a kinder approach can be taken, instead,” highlights Mr Ranjan.

He details a stalking case where a vulnerable patient had misunderstood the doctor’s concern and care as loving affection. However, instead of a legal approach, what the patient needed was actually mental health treatment. The stalking stopped eventually, after the patient received treatment.

Mr Ranjan advises to use a kinder approach towards vulnerable patients by understanding the underlying cause beforehand.
Mr Ranjan advises to use a kinder approach towards vulnerable patients by understanding the underlying cause beforehand.

“Think about the patient’s welfare,” comments Mr Ranjan, further highlighting that “the solution is not a legal solution, but care.”

Sometimes, there is a need to view the cases differently as the medical field consists of other professions as well. A paediatrician commented on Medscape, “for example, I would be less concerned about an ophthalmologist getting involved with a patient who has had general yearly visits than I would an internist or oncologist."

On the other hand, HCPs like psychiatrists often experience cases of patients seeking a romantic attachment. This is due to a longer period of contact between patient and psychiatrist.

Ethicists agree that the distinction between the fields and professions is valid, as some specialties create a more intimate relationship by nature, that makes the patient more vulnerable.

“Relationships are complicated,” says Dr Richard Martinez, Director of forensic psychiatry services at Denver Health Medical Centre in US. “Every ethical dilemma has to be evaluated and considered on a case-by-case basis,” adds Dr Martinez, who is also the author of several articles on ethical decision-making and the patient/physician relationship.

  ●  Doctor-Patient relationship in the era of social media
  ●  Should healthcare professionals have romantic relationships with patients?
  ●  Doctors: How to end a professional relationship with a patient

Maintaining professional boundaries

The Malaysian Medical Council’s (MMC) “Good Medical Practice” advises doctors to “avoid developing private and personal relationship with your patient, and discourage any attempt by a patient to become personally and privately involved with you.”

Dr Ng explains that dentists also need to “maintain absolute professionalism” with the patients. Photo credit: Dr Ng Woan Tyng
Dr Ng explains that dentists also need to “maintain absolute professionalism” with the patients. Photo credit: Dr Ng Woan Tyng

The same can be said for dentists as well. President of the Malaysian Dental Association, Dr Ng Woan Tyng, quotes from the Malaysian Dental Council’s (MDC) Code of Professional Conduct, “Maintenance of Professional Relationship” – saying that dental practitioners “shall at all times maintain absolute professionalism in his relationship with his patient.”

In regard to this, Mr Darryl Goon, Partner of Raja, Darryl & Loh explains, “the inference to be drawn from the use of the phrase ‘absolute professionalism in his relationship with his patients’ is that relationships other than a purely professional one is to be eschewed.”

Since both HCPs and patients may be responsible for going beyond boundaries, there is a need to recognise early warning signs and deal with the situations appropriately.

For instance, a doctor who recognises the patient’s inappropriate behaviours should avoid actions that may be seen as encouraging he/she – especially, when there is a need for intimate clinical examinations.

Mr Ranjan comments that doctors should explain the procedures to patients first. Having a chaperone in the room – as a witness or as reassurance for the patient – is also important to maintain the boundaries as well.

“We encourage all doctors to have a chaperone when you examine or even talk to a female patient… to safeguard the doctor and the patient,” echoes Dr Ravichandran R. Naidu, President of the Malaysian Medical Association (MMA).

Similarly, the receiving of inappropriate gifts or cards should be politely declined, as well as discouraging an inappropriate frequency of consultations.

Patients on the other hand, are not commonly advised about the boundaries. As such, the hospitals, clinics and online websites could provide the guidance about the nature of their relationship with doctors.

Dr Ravichandran encourages the existence of a chaperone during a consultation as a means of protection for both the doctor and the patient.
Dr Ravichandran encourages the existence of a chaperone during a consultation as a means of protection for both the doctor and the patient.

Terminating patient-physician relationship – not abandoning patient

However, in cases where HCPs are at their wits’ end, termination of patient-physician relationship may have to occur.

For example, when a HCP’s partner requires medical consultations, Dr Ng suggests the HCP to “either terminate your romantic relationship, or terminate your professional relationship, and refer him/her to another colleague.”

However, the termination of a professional patient-physician relationship should be done carefully – to avoid claims of “patient abandonment”.

A reasonable time should be chosen and an advance notice should be provided for the patient to search for an equally qualified replacement. The patient’s medical status and needs must be considered as well, including a proper documentation of the whole process.

Although cases of patients pursuing HCPs are rarely heard of in Malaysia, the decision still depends case-by-case. All in all, it is always better to take precaution.

“We don’t have any reported cases in Malaysia. So, it is difficult for us to say where’s the line to be drawn,” points out Mr Goon. “But, if we take a leaf from the other jurisdiction, we might be able to see something.” MIMS


Any comments or views? Join the discussion on our Facebook page – your platform to Engage, Inform and Inspire.



Sources:
https://www.theguardian.com/society/2012/oct/28/lovesick-patients-stalk-doctors-online
https://www.medscape.com/viewarticle/769104
https://www.medscape.com/viewarticle/882834
https://www.medscape.com/viewarticle/774295
https://www.themdu.com/guidance-and-advice/journals/mdu-journal-april-2013/maintaining-professional-boundaries
https://www.themdu.com/guidance-and-advice/latest-updates-and-advice/dealing-with-valentines-day-advances
http://careers.bmj.com/careers/advice/Crossing_boundaries%3A_dealing_with_amorous_advances_by_doctors_and_patients
https://theconversation.com/is-it-ever-ok-to-have-a-sexual-relationship-with-your-doctor-71302
https://www.legalmatch.com/law-library/article/sexual-relationships-with-patients.html?intakeredesigned=1
http://medicaleconomics.modernmedicine.com/medical-economics/news/removing-patient-your-practice-physicians-legal-and-ethical-responsibilities?page=full
http://www.physicianspractice.com/compliance/ethics-ending-patient-physician-relationship
https://www.tmlt.org/tmlt/tmlt-resources/newscenter/blog/2009/Terminating-patient-relationships.html