Patronizing your patient's business?

[shan564]

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I have a couple of patients who seem to be good at what they do, and I kinda want to go there, but it just sounds sketchy. For instance:

One patient's brother owns a golf course. Patient works there, and brother always comes to the appointments with patient. I'd been thinking about playing at that course anyway, but I don't want to make it seem like I'm expecting special treatment because of the doctor-patient relationship.

Another patient is starting a mechanic business, and doing some mechanic work for people informally in the meantime. Based on my knowledge of his psyche (which I won't disclose here in detail), I think that he's probably an exceptional and honest mechanic, especially now that his mental illness is treated. But I never would have thought to go to him if I didn't have an in-depth knowledge of his personality.

I feel like both of those things are conflicts of some sort for different reasons, but it's hard to identify exactly why...

 

[Psychotic]

I gotta say "no" but I am not sure why. Just doesn't sound smart...

 

[shan564]

I gotta say "no" but I am not sure why. Just doesn't sound smart...

Yeah, that's what I was thinking too. I feel like the answer is "no," but I'm not sure I can explain the reason...

And given that, what if a patient owns a business where I would have gone regardless of whether he/she is my patient?

 

[Ceke2002]

I have assisted my Psychiatrist with some online security questions/issues before, but nothing that required either of us to meet anywhere outside of the clinic setting, or that exceeded 5 minutes at the end of a session. Anything beyond that I really don't think I'd feel very comfortable about (and I'm sure neither would my Psychiatrist) because it would seem too much like a blurring of the boundaries. So my gut feel on this would be a 'no' as well.

 

[F0nzie]

Great topic. What are your thoughts on the following scenarios?

1. You go to the golf course and at the end of the day you receive a call from the manager who believes you may have returned the equipment in a damaged state. You are adamant that the damages were not there when you returned the items. Brother who owns the golf course gets notified about the damages and subsequently tells your patient. Patient comes in for a follow up and seems more distant than usual.

2. You get your car fixed at your patient's auto shop and he does a crappy job. Later you find out he overcharged you because the guy down the street charges 50% less and does better work. You subsequently develop some resentment and feel cheated. Now he's coming in for a follow up appointment with you.

 

[FlowRate]

I have assisted my Psychiatrist with some online security questions/issues before, but nothing that required either of us to meet anywhere outside of the clinic setting, or that exceeded 5 minutes at the end of a session. Anything beyond that I really don't think I'd feel very comfortable about (and I'm sure neither would my Psychiatrist) because it would seem too much like a blurring of the boundaries. So my gut feel on this would be a 'no' as well.

I think you touched on it. This is a boundaries issue.

Are your patients in therapy with you? Perhaps patronizing them could be part of discontinuation of therapy (patient has something of value to offer therapist.)

 

[peppy]

Great topic. What are your thoughts on the following scenarios?

1. You go to the golf course and at the end of the day you receive a call from the manager who believes you may have returned the equipment in a damaged state. You are adamant that the damages were not there when you returned the items. Brother who owns the golf course gets notified about the damages and subsequently tells your patient. Patient comes in for a follow up and seems more distant than usual.

2. You get your car fixed at your patient's auto shop and he does a crappy job. Later you find out he overcharged you because the guy down the street charges 50% less and does better work. You subsequently develop some resentment and feel cheated. Now he's coming in for a follow up appointment with you.

Yes, I think those are good examples of how this could become an awkward situation. You also wouldn't want him to think that he is obliged to give you a discount or favors to get good care.
Personally, I also try to avoid seeing patients in other settings because I don't want my presence to be uncomfortable for them. A lot of people are embarrassed about needing psychiatric care and I don't want them to feel that they have to explain who I am and how we know each other to their coworkers if their coworkers notice that we recognize each other.

I know of a psychiatrist who intentionally chose to get a job far from where they actually live so that they could avoid running into their patients outside of work.

 

[Ceke2002]

I know of a psychiatrist who intentionally chose to get a job far from where they actually live so that they could avoid running into their patients outside of work.

Here I believe it's actually recommended that Psychiatrists don't live in the same area that they work so as to reduce the possibility of running into patients outside of the clinic. I don't think it's like a hard and fast rule or anything, but from what I understand it is considered good practice especially from a personal safety standpoint.

 

[shan564]

Yeah, those are all good points. I guess I can just go to a different golf course. I genuinely wanted to play there (it's actually one of the least expensive golf courses in town, which is my primary criterion when deciding where to play), but I can suck it up and pay six extra dollars. And I was thinking about the mechanic because he's just about to start his own shop (needs more clients, currently doing it cheaply) and I have a friend who really needs repairs and doesn't have much money (match made in heaven?), but it's just a bad idea.

I'm wondering how this will pan out in the future. I'm currently a PGY3, and I hope to stay at the same institution when I graduate. Between inpatient, consults, ER, and outpatient, I imagine that I'll end up in a situation where I have to avoid half of my favorite places... maybe that's one reason why most of the older faculty members don't live in the same part of town (even though it's a nice area).

 

[Ceke2002]

Yeah, those are all good points. I guess I can just go to a different golf course. I genuinely wanted to play there (it's actually one of the least expensive golf courses in town, which is my primary criterion when deciding where to play), but I can suck it up and pay six extra dollars. And I was thinking about the mechanic because he's just about to start his own shop (needs more clients, currently doing it cheaply) and I have a friend who really needs repairs and doesn't have much money (match made in heaven?), but it's just a bad idea.

I'm wondering how this will pan out in the future. I'm currently a PGY3, and I hope to stay at the same institution when I graduate. Between inpatient, consults, ER, and outpatient, I imagine that I'll end up in a situation where I have to avoid half of my favorite places... maybe that's one reason why most of the older faculty members don't live in the same part of town (even though it's a nice area).

Not necessarily. I know I've mentioned before that my Psychiatrist and I have a lot of interests in common (snorkeling, bushwalking, various bands, and musical genres), and both frequent a lot of the same places, so the chances of us running into one another outside of the clinic is fairly high (I'm actually amazed it hasn't happened already). We've discussed how to handle things if this does eventuate, and his attitude is that we can just say a quick 'Hello, how you doing, have a good night' and leave it at that, but he also said he would leave it up to me and if I didn't feel comfortable saying hello then that would be fine as well - whatever I'm okay with (obviously not to the point of 'hey let's hang out together seeing as we're here at the same place anyway'). To me that scenario is completely different than either one of us saying 'Oh hey what are you up to this weekend? Me and my husband/wife are heading out to ABC hotel to see XYZ band play, we'll see you there about eight if you're going'. Same as if I was working in a particular shop or business and my Psychiatrist just happened to come in one day then I'd serve him like any other customer and it wouldn't be a big deal, but if he came in and said 'Oh I just wanted to see where you worked, I've been thinking of changing *insert whatever provider of business* for a while now', I'd be side eyeing him pretty hard and making it clear that we'd have something to talk about next session.

 

[OldPsychDoc]

I think that the difference here is you intentionally seeking out that business relationship. I've said before that I'm amazed at how often my paths cross with a patient or former patient--sometimes at church, once at a Springsteen concert, or finding out we have a mutual friend, or even once in my local Y branch shower room! If it appears at all that it is going to be a recurring issue, my standard speech is "at ____, outside of clinic, I'm not going to act as your doctor, so don't ask me for advice or refills. Likewise, no one will know that you are my patient unless you tell them or specifically authorize me (in writing) to tell them."

 

[smalltownpsych]

Here in this small town, dual relationships are inevitable. My ethical principle is to take steps to minimize them and potential for harm. In the two scenarios, the golf course on seems much less risky for potential harm and you already had reason to go there. In my town we only have so
Many restaurants and I won't avoid a decent one because of potential patients. We have a lot of mechanics so I probably wouldn't go to a patient. The other factor to consider is the patient's presenting problem and ability to maintain healthy interpersonal boundaries.