Can chiropractors dating former patients
Nor do all boundary transgressions between doctor and patient ultimately lead to sexual misconduct. A key factor in the identification of doctors at risk of violating boundaries is the enhanced vulnerability of a doctor to the transference–counter-transference dyad which occurs in varying degrees in every doctor–patient relationship.
Transference is “the unconscious assignment to others of feelings and attitudes that were originally associated with important figures” by the patient onto the doctor.
On the basis of this evidence, it is argued that the circumstances in which such relationships are ethically permissible are extremely limited and that official ‘sanctioning' of these relationships should be very much the exception, not the rule.
This is recognized within professional codes, for example by the New Zealand Medical Council which states that “the ethical doctor– patient relationship depends upon the doctor creating an environment of mutual respect and trust in which the patient can have confidence and safety”. It is an underlying principle of the concept of boundaries and it has been argued that it is the doctor's breach of fiduciary trust, not the patient's consent, which is the central issue regarding sexual misconduct. After 6 weeks in hospital, on the day of his planned discharge, he was accidentally given another patient's medication.In addition, ‘love transference' can be extremely capricious, often hiding a destructive hate transference that frighteningly erupts and engulfs the therapist and patient.Doctors are more vulnerable to counter-transference when the doctor unconsciously or subconsciously overidentifies with the patient's situation, so much so that one author comments:“The power of the subconsciously driven countertransference to create rationalisations that the sexual relationship with the patient is ‘special and the exception' to the usual rules of professional conduct should never be underestimated.” Such ‘overidentifiers' are often ‘situational reactors' who are responding to particular triggers such as marital discord, loss of important relationships and a professional crisis in their own lives.In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor–patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient.Only in very particular circumstances could such relationships be ethically permissible.