A Threat to the Physician-Patient Relationship

[DucktorQuack]

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[atsai3]

I'd like to address an overlooked, yet very serious, issue.

Just curious-- what makes you describe this as an "overlooked" issue?

 

[DucktorQuack]

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[billypilgrim37]

I saw a Glen Gabbard video where he dealt with it as such (paraphrasing, of course):

"Mary, I can't answer that question, because that's only going to get in the way of our therapeutic relationship and the work that we've been doing together. If I tell you I am attracted to you, then it changes our relationship, and I can't be of help to you anymore. If I tell you I'm not attracted to you, you might be hurt, and again, I can't be of as much help to you anymore. We can and should certainly talk about what it feels like for you to be in that situation and to have those strong feelings."

 

[whopper]

Gabbard, IMHO, pretty much always from my own experience given the best advice from the various books I've seen on psychotherapy.

In a hospital setting, my advice is you'll likely want the patient transferred to someone else if there's a problem along these lines. You don't have to do this, but at least consider it. In hospital systems, there's usually a few psychiatrists and one can pick up one you drop.

In outpatient, this is more difficult because you've likely known the patient on a more intimate level (longer duration of treatment, one-on-one interviews possibly several times a week to month, and it's harder to switch to another doctor in outpatient). A patient might not want to leave you, and you may feel there's good reason to not terminate the relationship (e.g. the person took months to open up to you, they'll likely face that same problem with another doctor).

 

[MDyoucantseeme]

I don't think this is a serious post. My psychiatrist said the only reason psychiatrists do not mess around with attractive and interested (or just interested) patients is because they will lose their license when they are caught. I believe she said there was a time frame on how long a patient had to be not a patient for this person to be considered ethically and legally f-able. (sorry for the bad language)

Be honest this is the only reason you do not f your attractive and interested (or just interested) patients and you know it.

 

[sunlioness]

Actually I've never had a patient I particularly wanted to "f". I suppose it's within the realm of possibility that I may be attracted to a patient one day, but I like to think that I would refrain from doing so. Not because of the legal ramifications, but because boundary violations hurt patients. I believe that's true whether you're "f-ing" them or even "just" meeting them for coffee (though definitely to different degrees). And that the legal/licensing consequences are the correct response to deeply unethical and harmful behavior.

 

[whopper]

Actually I've never had a patient I particularly wanted to "f"

Definitely something I was in until private practice. No I never actually wanted to date a patient, but there's a difference between working at a place where a majority of the patients look 10 years older than they are, smell bad, haven't bathed for days, are missing several teeth, have IVDA track marks on their arms, and a place where almost all of the patients are no different than the people I usually hang out with in terms of SES, and many of them are attractive and intelligent women, just that they're my patient. I can't allow myself to mentally go down the road of even thinking of becoming intimate with a patient. The few times where I started thinking a patient was attractive just for a few seconds, it made me feel like I was violating my professional ethics.

Very different clinical settings yield different types of patients. I worked in one place in residency in outpatient and over 90% of the patients showed up, another place (the place where the hospital referred all the people they thought were malingering for a 3 hots and a cot), hardly any of them showed up. Hey makes sense to me. The outpatient place didn't give out free food. If it did I bet you the attendance rates would've been sky-high.

 

[billypilgrim37]

My psychiatrist said the only reason psychiatrists do not mess around with attractive and interested (or just interested) patients is because they will lose their license when they are caught.

Just because your psychiatrist has significant boundary issues doesn't mean we all do.

 

[MDyoucantseeme]

Just because your psychiatrist has significant boundary issues doesn't mean we all do.

If all psychiatrists don't have boundary issues they/you would not need the law/rule/sanction to keep them/you in line. If all psychiatrists don't have boundary issues why are the ramifications so serious after the first offense?

threat |θret|
noun
1 a statement of an intention to inflict pain, injury, damage, or other hostile action on someone in retribution for something done or not done : members of her family have received death threats.
• Law a menace of bodily harm, such as may restrain a person's freedom of action.
2 a person or thing likely to cause damage or danger : hurricane damage poses a major threat to many coastal communities.
• [in sing. ] the possibility of trouble, danger, or ruin : the company faces the threat of bankruptcy | thousands of railroad jobs came under threat.

I define the word threat to gesture towards the OP's telling terminology. Threat implies a certain degree of likelihood which goes beyond mere possibility. If it was not likely to occur it would not be a "threat".

 

[MDyoucantseeme]

Definitely something I was in until private practice. No I never actually wanted to date a patient, but there's a difference between working at a place where a majority of the patients look 10 years older than they are, smell bad, haven't bathed for days, are missing several teeth, have IVDA track marks on their arms, and a place where almost all of the patients are no different than the people I usually hang out with in terms of SES, and many of them are attractive and intelligent women, just that they're my patient. I can't allow myself to mentally go down the road of even thinking of becoming intimate with a patient. The few times where I started thinking a patient was attractive just for a few seconds, it made me feel like I was violating my professional ethics.

Very different clinical settings yield different types of patients. I worked in one place in residency in outpatient and over 90% of the patients showed up, another place (the place where the hospital referred all the people they thought were malingering for a 3 hots and a cot), hardly any of them showed up. Hey makes sense to me. The outpatient place didn't give out free food. If it did I bet you the attendance rates would've been sky-high.

The shear length of this post implies you are protesting too much. Especially the luxury of detail you use to describe how unattractive your patients are to you.

 

[heyjack70]

Trolling

 

[MDyoucantseeme]

Actually I've never had a patient I particularly wanted to "f". I suppose it's within the realm of possibility that I may be attracted to a patient one day, but I like to think that I would refrain from doing so. Not because of the legal ramifications, but because boundary violations hurt patients. I believe that's true whether you're "f-ing" them or even "just" meeting them for coffee (though definitely to different degrees). And that the legal/licensing consequences are the correct response to deeply unethical and harmful behavior.

This is too bad. You should have been a tenured english professor, then you could f whoever you wanted, provided they were not a current student.

 

[billypilgrim37]

If all psychiatrists don't have boundary issues they/you would not need the law/rule/sanction to keep them/you in line. If all psychiatrists don't have boundary issues why are the ramifications so serious after the first offense?

Your cluelessness is awesome.

a) Your psychiatrist's generalization to all psychiatrists demonstrates some fairly alarming lack of mentalization skills on his/her part.

b) Your psychiatrist clearly has boundary issues for sharing this ridiculous and provocative "pearl" with you as a patient.

c) Just because you think you and your psychiatrist will require external pressure to prevent you from rubbing your genitals against your patients' genitals doesn't mean the rest of us didn't, say, develop some ego function during our development.

Beyond losing license, other reasons to not have sex with willing patients include

a) My wife wouldn't appreciate it.

b) I became a psychiatrist instead of a gigolo because presumably I wanted to do things other than just have sex. Having sex with a patient undermines your ability to help them. How would a woman possibly feel safe and be able to trust me in a therapeutic relationship if we were having more than a therapeutic relationship?

c) As a male, the chances of a patient who would want to sleep with me (their psychiatrist) having pretty significant personality pathology is pretty tremendous. If you go to a bar, and somebody says, hey that hot chick wants to do you, but there's a really good chance she will become a stalker, bash your car with a golf club, and call you up at 3 in the morning threatening to kill herself, you'd probably pass, even with a few drinks in you. It's even easier to avoid these traps when the piece of paper in front of you has a psychiatric diagnosis on it, you're sober, and it's 10AM.

d) I'm probably better at psychotherapy than I am in bed. (Of course, maybe that's why I became a psychiatrist instead of a gigolo).

 

[whopper]

If all psychiatrists don't have boundary issues they/you would not need the law/rule/sanction to keep them/you in line.

No one here is saying "all psychiatrists" don't have boundary issues. Psychiatrists are human beings. We, like all human beings, exist on a spectrum with some good, some bad. This sounds to me like classic black and white thinking.

Any profession will have the chance that there will be those that will exploit and corrupt what it's about. When the profession has several people in it, it become something where it will happen, just hopefully less often than not.

Police, politicians, clergy, physicians, teachers, what have you are not spotless.

If you want to go on a tirade and condemn a profession because the terrible acts of a few, go right on ahead. It's a waste or your time and ours. If you are angry at psychiatrists due to something that happened to you in the past where your anger is justified, then I would sympathize with you, but this forum is not the right place to address that anger-the state medical board is. Lodge a complaint.

From here on, unless there's a change, I'd recommend there be a ban on the poster because this is either classic trolling or anger that's better directed to other avenues other than this one.

 

[MDyoucantseeme]

Your cluelessness is awesome.

a) Your psychiatrist's generalization to all psychiatrists demonstrates some fairly alarming lack of mentalization skills on his/her part.

b) Your psychiatrist clearly has boundary issues for sharing this ridiculous and provocative "pearl" with you as a patient.

c) Just because you think you and your psychiatrist will require external pressure to prevent you from rubbing your genitals against your patients' genitals doesn't mean the rest of us didn't, say, develop some ego function during our development.

Beyond losing license, other reasons to not have sex with willing patients include

a) My wife wouldn't appreciate it.

b) I became a psychiatrist instead of a gigolo because presumably I wanted to do things other than just have sex. Having sex with a patient undermines your ability to help them. How would a woman possibly feel safe and be able to trust me in a therapeutic relationship if we were having more than a therapeutic relationship?

c) As a male, the chances of a patient who would want to sleep with me (their psychiatrist) having pretty significant personality pathology is pretty tremendous. If you go to a bar, and somebody says, hey that hot chick wants to do you, but there's a really good chance she will become a stalker, bash your car with a golf club, and call you up at 3 in the morning threatening to kill herself, you'd probably pass, even with a few drinks in you. It's even easier to avoid these traps when the piece of paper in front of you has a psychiatric diagnosis on it, you're sober, and it's 10AM.

d) I'm probably better at psychotherapy than I am in bed. (Of course, maybe that's why I became a psychiatrist instead of a gigolo).

I'm sure all the psychiatrists who lost their license for however many years went into it with the intention of doing so.

 

[MDyoucantseeme]

No one here is saying "all psychiatrists" don't have boundary issues. Psychiatrists are human beings. We, like all human beings, exist on a spectrum with some good, some bad. This sounds to me like classic black and white thinking.

Any profession will have the chance that there will be those that will exploit and corrupt what it's about. When the profession has several people in it, it become something where it will happen, just hopefully less often than not.

Police, politicians, clergy, physicians, teachers, what have you are not spotless.

If you want to go on a tirade and condemn a profession because the terrible acts of a few, go right on ahead. It's a waste or your time and ours. If you are angry at psychiatrists due to something that happened to you in the past where your anger is justified, then I would sympathize with you, but this forum is not the right place to address that anger-the state medical board is. Lodge a complaint.

From here on, unless there's a change, I'd recommend there be a ban on the poster because this is either classic trolling or anger that's better directed to other avenues other than this one.

It is human for the powerful to exploit the weak. Psychiatrists are human. It was not me, but your friend, who said "not all psychiatrists have boundary issues". Also, I did not go on a "tirade" but wrote a one line post pointing out how this type of thing goes on in other fields, that seem devoted to maintaining current rules and structures that perpetuate exploitation.

Also, I don't think it is very intellectually sophisticated of you to try to get rid of me just because what I am saying does not go along with the consensus here. You basically are trying to wheedle out people who disagree with you so this forum/post can be a circle jerk of how ethical psychiatrists are and how much they love their wives.

In my area they have a parking lot near the hospital so the doctors can park for free, without showing up with their mistresses so close to where they work.

 

[OldPsychDoc]

...d) I'm probably better at psychotherapy than I am in bed...

That's what she said.

 

[sunlioness]

If all psychiatrists don't have boundary issues they/you would not need the law/rule/sanction to keep them/you in line. If all psychiatrists don't have boundary issues why are the ramifications so serious after the first offense?

Why do we need a law to keep people from killing other people? And why are the consequences so severe after the first offense? That must make you a murderer.

 

[billypilgrim37]

That's what she said.

That's what she free associated?

 

[sunlioness]

That's what she free associated?

Giggity.

 

[whopper]

 

[DucktorQuack]

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