After your rotation, is it appropriate to call up a patient out for drinks?

[Law2Doc]

Agreed with the above... I rarely will refill something relatively innocuous that they're already on such as lisinopril or albuterol and it's a weekend. But not abx, narcs, benzos, or amphetamines.

As far as the relationship question goes, the standardized tests during med school were very black-and-white about this. If you first met the person because they were your pt, you may not have an out-of-work relationship with them, ever, full-stop. I'm not such an absolutist; and I believe that setting strict emotional barriers between yourself and your patients may actually impede health care. On the other hand, boning your patients is unacceptable unless you are a U.S. congressman from Tennessee.

A point above was that if you go down the road of "out of work relationships" this sometimes could lead to the "boning", especially if alcohol and other bad judgment is involved in the encounter. Or can lead to tacit endorsement of activities (smoking, drinking, drugs, non-heart healthy diet, etc) that the patient is subconsciously relying on you to put the brakes on if you are there. You can never ethically be just a buddy and one of the guys if you also had ever been in the role of caregiver.

I agree that writing family scrips is probably not wise, particularly now days where it's trivial to just go to the NP working at CVS or Walmart who is happy to see you immediately and prescribe you things as freely as a Pez dispenser.

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[michaelrack]

A point above was that if you go down the road of "out of work relationships" this sometimes could lead to the "boning".

The male OP and the male patient are both supposedly heterosexual...... not that there's anything wrong with it if they aren't

 

[Top Gun]

Just FYI, the AMA code of ethics provides that at a Minimum you must end your role as physician before asking out a patient, but says that in many cases a relationship will still be unethical, as the balance of power and position will always be there. This was one of the original prohibitions in the Hippocratic oath, and as a physician is seen in a paternalistic role, some commentators suggest this should be ethically regarded like incest.
So I think you might be out on a Bit of a limb by yourself saying it's globally "fine", though some would find it less ethically troubling than others depending one the facts and circumstances of each case. Not surprisingly, the doctors least likely to abuse their position in an emotional relationship are also probably those least likely to ask out a patient in the first place.

I'm sure things can differ in a rural setting where the whole town is your patient, and you can't maintain a professional distance, but I don't know if that's the situation we are discussing.

Also lots of worms in the can in the above situation. Your doctor asks you out for drinks. Is he condoning drinking? How many drinks? And will the patient be trusting the doctor in terms of what's healthy? Was this really a platonic exchange of numbers? Does the patient think this too? What if the patient lights up a cigarette -- are you going to stop him? Or eats a greasy cheeseburger, and you just treated him for, say, CAD? If you don't, is his doctor condoning these actions? Even if its nonsexual, going out for drinks with someone you met as your patient creates a lot of messy situations.

Law2Doc, he is not asking the patient out. The patient invited him for a conversation regarding their family history, and he wants to know if he should accept the patient's invitation. Asking out implies a sexual relationship, which is not the case here. As far as we know, its platonic, so I don't really see the problem unless the conversation becomes medical. Now, if there was any implication of romance, that would be a big no-no, but that doesn't seem to be the case here.

On a side note, I have a few family friends as patients. They were actually friends before they became patients. We had them over for dinner at our house last night. As long as we don't discuss anything medical, or go in the direction of romantic/sexual, its fine.

 

[Raryn]

I swear, my FM preceptor had half his church as patients. Mostly because he was an awesome person and physician both.

There is absolutely nothing ethically wrong with non-romantic non-sexual interactions with your patients outside of the clinic, particularly if you just keep your mouth shut regarding any health information. "Tacit endorsement" of eating cheeseburgers might be a hangup L2D has, but not one that I've seen espoused in any professional code of medical ethics, much less by a licensing board.

 

[Perrotfish]

As far as the relationship question goes, the standardized tests during med school were very black-and-white about this. If you first met the person because they were your pt, you may not have an out-of-work relationship with them, ever, full-stop. I'm not such an absolutist; and I believe that setting strict emotional barriers between yourself and your patients may actually impede health care. On the other hand, boning your patients is unacceptable unless you are a U.S. congressman from Tennessee.

The standardized tests weren't as black and white at my school. We were taught that the legal standard at this time is just that you need to cut off your professional relationship with a patient before starting (or even suggeseting) a personal one. As long as you don't even mention a personal relationship before you finish a professional one you're in the clear. We were also taught the only legal exception to this rule was psychatrists, whose professional code of ethics dictate that they not engage in a personal relationship with any former patient at any time, whether or not their professional relationship is terminated.

Of course ethically you could argue that there are grey areas. Certainly an oncologist starting a personal, sexual relationship with someone he has care for for a decade is unethical, even if he breaks off his physician relationship with them before asking them out. However the OP's situation doesn't seem like a grey area at all. Its a non-sexual relationship, a medical student is not a provider, and the relationship they had as patient and pseudoprovider was brief, unemotional, and is now terminated.

 

[Law2Doc]

... "Tacit endorsement" of eating cheeseburgers might be a hangup L2D has, but not one that I've seen espoused in any professional code of medical ethics, much less by a licensing board.

if you know from your prior care that the guy is supposed to be on a strict heart healthy diet, agreeing to go out for food not on that diet is problematic. For the same reason doctors are supposed to counsel patients not to smoke, drink, use drugs or engage in other condition specific health risks, they aren't supposed to agree to go out and do any of those activities with them.

 

[Law2Doc]

Law2Doc, he is not asking the patient out. The patient invited him for a conversation regarding their family history, and he wants to know if he should accept the patient's invitation. Asking out implies a sexual relationship, which is not the case here. As far as we know, its platonic, so I don't really see the problem unless the conversation becomes medical. Now, if there was any implication of romance, that would be a big no-no, but that doesn't seem to be the case here.

On a side note, I have a few family friends as patients. They were actually friends before they became patients. We had them over for dinner at our house last night. As long as we don't discuss anything medical, or go in the direction of romantic/sexual, its fine.

Well, the discussion was "going out for drinks". I'm not sure that necessarily jibes with just wanting further opportunity to discuss family history, and a lot of the initial story sounds a bit contrived. Just because OP deems it strictly platonic doesn't mean the other guy does.

Again, as discussed previously, there's a huge difference where you meet a person in the caregiver setting and where they were friends/relatives well before they became your patients.

 

[Perrotfish]

if you know from your prior care that the guy is supposed to be on a strict heart healthy diet, agreeing to go out for food not on that diet is problematic. For the same reason doctors are supposed to counsel patients not to smoke, drink, use drugs or engage in other condition specific health risks, they aren't supposed to agree to go out and do any of those activities with them.

I disagree with this on so many levels.

1) You are responsible for informing your patients about what, according to our most current research, are the costs and benifits of different types of behavior. You are not responsible for then encouraging them to make the 'right' choice, and in fact telling them which choice is correct is 'right', beyond telling them the risks and benifits of their chioces, is an example of paternalism an is by modern standards unethical.

2) Similarly, you are not an example for your patients. Just as they have a right to their choices, you have a right to yours. You know the risks and benifits of smoking, drinking, and eating fast food. You then have a right to make your decisions and live with the consequences

3) Even if you were for some reason responsible for your patient's behavior, once your dishcarge them as your patient they are no longer your patient. If you are no longer their physician you have no more responsibility for their health than anyone else on the street.

4) Similary, assuming the relationship wasn't about their mental health, once you terminate your professional relationship with them you have as much right to a personal relationship with them as anyone else.

5) One last thing: The idea that a cheeseburger (lean red meat + cheese) is not 'heart healthy' is an outdated theory. There is nothing the least bit unhealthy about a high fat, high protein diet unless you already have significant kidney damage (and even then the research is equivocal). Athrosclerosis is not primarily a function of the cholesterol in your foods, but rather the cholesterol made in your liver. Your liver puts out more cholesterol when its insulin resistant, and insulin resistance is a product of eating too many simple carbs. The unhealthiest thing about a hamburger is actually probably the bun.

Can Law2Doc haz cheezburger? Yes he can.

 

[Raryn]

if you know from your prior care that the guy is supposed to be on a strict heart healthy diet, agreeing to go out for food not on that diet is problematic. For the same reason doctors are supposed to counsel patients not to smoke, drink, use drugs or engage in other condition specific health risks, they aren't supposed to agree to go out and do any of those activities with them.

Personal responsibility. I'm obligated to counsel them that smoking and excessive drinking are bad for them, but what they do with that information is up to them. I'm not going to invite a patient out to go binge on cocaine, but if we meet for lunch and they have a cheeseburger and a beer, that's on their heads, not mine. The fact that I'd probably order something similar is my own responsibility, but has nothing whatsoever to do with any provider-patient relationship (or lack thereof).

 

[smq123]

I tend to think FB friending across a generation gap is weird to begin with but that's just me

Your attitude might change when you become a resident. As a resident, the way your attendings treat you will be different (as genuine friends/colleagues, not just as students who you won't see again in 2 months), and you'll interact more closely with attendings of varying generations. So it becomes more common, I think, to become FB friends with people who are quite different from you in age.

 

[SpecterGT260]

Your attitude might change when you become a resident. As a resident, the way your attendings treat you will be different (as genuine friends/colleagues, not just as students who you won't see again in 2 months), and you'll interact more closely with attendings of varying generations. So it becomes more common, I think, to become FB friends with people who are quite different from you in age.

It's possible. It is also possible that I will get rid of the account all together (have done so a couple times and end up getting it back for a variety of reasons).

I was just saying that social networking, for me, is strictly social. I will also routinely remove people whom I know I will not have contact with again . I don't see myself ever friending patients, which was the subject matter of the post I responded to with that.

 

[odieoh]

I stand behind this post. You as a physician have an unfair leverage over the patient even if you never treat him again. That in itself can cause all kinds of headaches.

In the situation described by the OP, what kind of "leverage" is there? What is all this BS about "balance of power" and "leverage?" He's talking about going out and discussing some common interests, where in the world will any kind of balance of power come into play? Maybe you guys socialize differently than I do. . .

 

[reno911]

I disagree with this on so many levels.

1) You are responsible for informing your patients about what, according to our most current research, are the costs and benifits of different types of behavior. You are not responsible for then encouraging them to make the 'right' choice, and in fact telling them which choice is correct is 'right', beyond telling them the risks and benifits of their chioces, is an example of paternalism an is by modern standards unethical.

2) Similarly, you are not an example for your patients. Just as they have a right to their choices, you have a right to yours. You know the risks and benifits of smoking, drinking, and eating fast food. You then have a right to make your decisions and live with the consequences

3) Even if you were for some reason responsible for your patient's behavior, once your dishcarge them as your patient they are no longer your patient. If you are no longer their physician you have no more responsibility for their health than anyone else on the street.

4) Similary, assuming the relationship wasn't about their mental health, once you terminate your professional relationship with them you have as much right to a personal relationship with them as anyone else.

5) One last thing: The idea that a cheeseburger (lean red meat + cheese) is not 'heart healthy' is an outdated theory. There is nothing the least bit unhealthy about a high fat, high protein diet unless you already have significant kidney damage (and even then the research is equivocal). Athrosclerosis is not primarily a function of the cholesterol in your foods, but rather the cholesterol made in your liver. Your liver puts out more cholesterol when its insulin resistant, and insulin resistance is a product of eating too many simple carbs. The unhealthiest thing about a hamburger is actually probably the bun.

Can Law2Doc haz cheezburger? Yes he can.

1. Encouraging your patients to make what you feel is the best decision is not paternalism. Unless you have a really wacky definition of paternalism.

2. Agree

3. Agree with the understanding that "dishcarging" a patient is often a lengthy process and requires a lot more than the doc saying "I'm not taking care of you anymore"/

4. You may think so, but this is certainly not universally agreed upon, which is why one can run into trouble. Moreover, just because the relationship was not "about their mental health", doesn't mean that you can have any sort of relationship with a past patient that you want. I'm not a mental health practitioner or even a PCP, but I often come across patient's mental health information when I'm dealing with relatively unrelated problems.

5. Kind of agree with the point you're making, but you're going to need to know a lot about a patient's health and diet to determine how acceptable or unacceptable a cheese burger would be for them to eat. Anyway, as I'm sure you realize, this wasn't the point. The specific food wasn't really important to the point being made.

 

[docu]

maybe im wrong, but from what i gather, the only dr patient relationship not allowed is actually if it were an intimate relationship like a hetero male and female, or gay females or males with intention of having a physical relationship or get married. in your case it is just a friend, not a relationship or even an intent for a relationship. how can that break the dr-patient relationship. i dont see how that can be wrong. i see no harm in that, although just be careful as you should with all strangers. also, don't encourage drinking to your patients, maybe make sure he has a sprite or a water and make sure he is eating healthy as much as possible. this guy seems like a friend of the family so why should he be restricted from your life?

good luck.

 

[nancysinatra]

that's what I meant too.

The prohibitions against business deals (including the above and also loans between the pt/doc) as well as against sex are absolute for psychiatrists. Other docs have more options. Psychiatrists aren't supposed to ever have sex with a former patient.

So here's a couple scenarios:

1) Let's say I'm a psych intern and I'm on call one night and a guy comes into the ER and I treat him in some limited way (say for panic attack--it's not like I'm calling all his relatives for collateral and committing him to the inpatient unit). Then he leaves. 5 years later I meet the same guy at a Star Trek convention. And say I don't recognize him or remember that night in the EC. And let's say our shared love for sci fi is so great we get married and consummate the relationship. Then one day, we get divorced, and as he is sorting through old paperwork, he sees my name on his discharge summary from that night long ago. Then he complains to the APA, thinking it will help him in our custody battle to discredit me. Will the APA and the state board get on my back?

2) Let's say I work in a rural area, where I'm the only psychiatrist for 200 miles, and my spouse is in an MVA, and he needs surgery, and then becomes delirious and starts pulling his lines out. And say the surgeons are just out of their minds not sure what to order for this condition. And they call me. If I recommend haldol, am I going to be in trouble?

3) What do you say if you run into your patient in (or near, as happened to me) a liquor store? Not that long ago I parked outside a strip mall that has a bookstore and a liquor store (I was going to the bookstore). I saw my patient walking by with her beau! I quickly ducked into my car.

4) Most antidepressants are prescribed by primary care docs. Do they have to follow the same rules? What about doctors who are double boarded?

 

[deleted87716]

Most antidepressants are prescribed by primary care docs. Do they have to follow the same rules? What about doctors who are double boarded?

The "rules," such as they are, don't change based on one's specialty.

 

[michaelrack]

So here's a couple scenarios:

1) Let's say I'm a psych intern and I'm on call one night and a guy comes into the ER and I treat him in some limited way (say for panic attack--it's not like I'm calling all his relatives for collateral and committing him to the inpatient unit). Then he leaves. 5 years later I meet the same guy at a Star Trek convention. And say I don't recognize him or remember that night in the EC. And let's say our shared love for sci fi is so great we get married and consummate the relationship. Then one day, we get divorced, and as he is sorting through old paperwork, he sees my name on his discharge summary from that night long ago. Then he complains to the APA, thinking it will help him in our custody battle to discredit me. Will the APA and the state board get on my back?

2) Let's say I work in a rural area, where I'm the only psychiatrist for 200 miles, and my spouse is in an MVA, and he needs surgery, and then becomes delirious and starts pulling his lines out. And say the surgeons are just out of their minds not sure what to order for this condition. And they call me. If I recommend haldol, am I going to be in trouble?

3) What do you say if you run into your patient in (or near, as happened to me) a liquor store? Not that long ago I parked outside a strip mall that has a bookstore and a liquor store (I was going to the bookstore). I saw my patient walking by with her beau! I quickly ducked into my car.

4) Most antidepressants are prescribed by primary care docs. Do they have to follow the same rules? What about doctors who are double boarded?

1. You are potentially in trouble, better hope the board/apa believes your story
2. You should be ok
3. say nothing; I think you did the right thing
4. There is no clear answer for double boarded docs, although if they primarily practice psychiatry, they are probably bound by psych rules. I am IM/sleep and psych- I guess I could probably get away (if I were single) with having a relationship with a former sleep apnea patient, but not a former depression patient I met while doing a locum tenens psych assignment. I am married so hopefully would never get into a situation like this, but if I did my defense would be that I am a member of the American College of Physicians and follow its ethical rules- note the APA's code of ethics (I will try to avoid becoming a test legal case for this concept)

 

[deleted87716]

my defense would be that I am a member of the American College of Physicians and follow its ethical rules- note the APA's code of ethics (I will try to avoid becoming a test legal case for this concept)

Good plan, since you would be judged by your state BOM, not a specialty society.

 

[wholeheartedly]

Good plan, since you would be judged by your state BOM, not a specialty society.

Couldn't your specialty society decide to boot you? In addition to whatever the state board and or legal entities to decide.

 

[Law2Doc]

...
1) You are responsible for informing your patients about what, according to our most current research, are the costs and benifits of different types of behavior. You are not responsible for then encouraging them to make the 'right' choice, and in fact telling them which choice is correct is 'right', beyond telling them the risks and benifits of their chioces, is an example of paternalism an is by modern standards unethical.

2) Similarly, you are not an example for your patients. Just as they have a right to their choices, you have a right to yours. You know the risks and benifits of smoking, drinking, and eating fast food. You then have a right to make your decisions and live with the consequences....

disagree. Doctors are supposed to counsel patients on various health impacting choices. Did you miss all those points on your CS exam where you were supposed to be counseling your patient not to smoke, drink, do drugs? Plus studies on smoking have affirmed that doctors telling their patients to stop smoking, etc absolutely do have an impact. Patients often know the risks, but until a doctor tells them "you need to stop smoking", they don't. letting your patient know the risks but not encouraging them toward a certain action is not good medicine. Call it paternalistic, but yes, you are supposed to take that role. Even if it means you are the guy putting a damper on the evening. Which is why I'm suggesting maybe you need to bow out of certain social settings like going out to drinks with your patients.

 

[Shinken]

4) Similary, assuming the relationship wasn't about their mental health, once you terminate your professional relationship with them you have as much right to a personal relationship with them as anyone else.

I would caution you about this point. Depending on how your state's Medical Board is, having a relationship with a former patient could become a huge issue (as in, loss of licensure).

In Ohio, where the Medical Board is tough and sometimes -in my opinion- unreasonable, there have been several cases of physicians losing their licenses because relationships with former patients have gone sour, and the former patient reports the physician (now ex-lover, ex-husband) to the Medical Board. They accuse them of inappropriate relationship, abuse of power, whatever they can think of, and the physician almost always loses that battle.

An attorney that advises us on cases like these has stated that the balance of power is still seen as favoring the doctor even after a patient is no longer a patient. Argument can be made that the patient felt compelled to date / sleep with / etc. with the doctor due to the perceived power or authority of the doctor (yes, even after the patient is no longer a patient). The Medical Board will almost always side with the patient, since the patient is the person with the least power and is seen as the victim (at least in Ohio).

I know this sounds ridiculous, but it doesn't matter what I think, it doesn't matter what you think. What matters is what the Medical Board thinks.

Tread carefully (VERY carefully) when considering an intimate relationship with a former patient, regardless of how much time has ellapsed since you last saw that patient.

Finally, having a relationship with a person is not a right, it's a privilege (I know what you meant, though).

 

[Poetic Silence]

disagree. Doctors are supposed to counsel patients on various health impacting choices. Did you miss all those points on your CS exam where you were supposed to be counseling your patient not to smoke, drink, do drugs? Plus studies on smoking have affirmed that doctors telling their patients to stop smoking, etc absolutely do have an impact. Patients often know the risks, but until a doctor tells them "you need to stop smoking", they don't. letting your patient know the risks but not encouraging them toward a certain action is not good medicine. Call it paternalistic, but yes, you are supposed to take that role. Even if it means you are the guy putting a damper on the evening. Which is why I'm suggesting maybe you need to bow out of certain social settings like going out to drinks with your patients.

And that concludes another episode of Common Sense. Brought to you by The Voice of Reason. Thank you.

 

[SpecterGT260]

disagree. Doctors are supposed to counsel patients on various health impacting choices. Did you miss all those points on your CS exam where you were supposed to be counseling your patient not to smoke, drink, do drugs? Plus studies on smoking have affirmed that doctors telling their patients to stop smoking, etc absolutely do have an impact. Patients often know the risks, but until a doctor tells them "you need to stop smoking", they don't. letting your patient know the risks but not encouraging them toward a certain action is not good medicine. Call it paternalistic, but yes, you are supposed to take that role. Even if it means you are the guy putting a damper on the evening. Which is why I'm suggesting maybe you need to bow out of certain social settings like going out to drinks with your patients.

That's a matter of perspective and opinion. I'm of the opinion that I'm not their damn babysitter and once they have the information it is on them

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[smq123]

disagree. Doctors are supposed to counsel patients on various health impacting choices. Did you miss all those points on your CS exam where you were supposed to be counseling your patient not to smoke, drink, do drugs? Plus studies on smoking have affirmed that doctors telling their patients to stop smoking, etc absolutely do have an impact. Patients often know the risks, but until a doctor tells them "you need to stop smoking", they don't. letting your patient know the risks but not encouraging them toward a certain action is not good medicine. Call it paternalistic, but yes, you are supposed to take that role. Even if it means you are the guy putting a damper on the evening. Which is why I'm suggesting maybe you need to bow out of certain social settings like going out to drinks with your patients.

Do you not eat out at restaurants at all? Because you might run into a patient and a patient might see you eating something unhealthy?

Are doctors allowed to have a life outside of medicine? Or is that also not permitted?

 

[SpecterGT260]

Do you not eat out at restaurants at all? Because you might run into a patient and a patient might see you eating something unhealthy?

Are doctors allowed to have a life outside of medicine? Or is that also not permitted?

Although I don't entirely accept this scenario, I guess it depends on how one practices. This is why I view doctors as information sources and not life coaches. If you're life coaching you are going to be made a hypocrite. "Hey doc, didn't you say I shouldn't eat a ton of salt? ". "No, I said if you want your BP to drop you should. If you want to die of a stroke years before your time you should annihilate these buffalo wings right now. But its your choice.

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[michaelrack]

Couldn't your specialty society decide to boot you? In addition to whatever the state board and or legal entities to decide.

yes- and if the APA boots or censures a psychiatrist, this is a black mark on his record that follows him around forever (of course the APA can only discipline members). In addition if the patient was seen at a psych hospital, she can take action through the hospital and try to get the psychiatrist's privileges revoked.

 

[deleted87716]

Couldn't your specialty society decide to boot you? In addition to whatever the state board and or legal entities to decide.

As a past-president of a state specialty society, I see no reason why they should. Specialty societies aren't involved in enforcement. That's the BOM's job. A medical license is not required for membership in most specialty societies, as there are plenty of retired docs who continue to pay their dues, attend meetings, etc.

 

[michaelrack]

As a past-president of a state specialty society, I see no reason why they should. Specialty societies aren't involved in enforcement. A medical license is not required for membership in most specialty societies, as there are plenty of retired docs who continue to pay their dues, attend meetings, etc.

The American Psychiatric Association is involved in enforcement and does have a board of ethics to investigate complaints

http://www.psych.org/practice/ethics

 

[deleted87716]

The American Psychiatric Association is involved in enforcement and does have a board of ethics to investigate complaints

They don't have any legal authority to revoke anyone's license, however. All they can do is kick somebody out of the clubhouse.

 

[michaelrack]

They don't have any legal authority to revoke anyone's license, however. All they can do is kick somebody out of the clubhouse.

You are right, but that is going to have consequences- that is something that a psych is going to have to list on all of his apps (hospital privileges, etc)

 

[gutonc]

They don't have any legal authority to revoke anyone's license, however. All they can do is kick somebody out of the clubhouse.

You are right, but that is going to have consequences- that is something that a psych is going to have to list on all of his apps (hospital privileges, etc)

You're both pretty.

Seriously though, both are good points. Censure by a professional society will not result in revocation of a license in and of itself, it can definitely cause trouble with future licensing, credentialing and job applications. Also, a professional society censure would be discovered if a licensee is investigated for another issue and is probably not going to help the case.

 

[KnuxNole]

disagree. Doctors are supposed to counsel patients on various health impacting choices. Did you miss all those points on your CS exam where you were supposed to be counseling your patient not to smoke, drink, do drugs? Plus studies on smoking have affirmed that doctors telling their patients to stop smoking, etc absolutely do have an impact. Patients often know the risks, but until a doctor tells them "you need to stop smoking", they don't. letting your patient know the risks but not encouraging them toward a certain action is not good medicine. Call it paternalistic, but yes, you are supposed to take that role. Even if it means you are the guy putting a damper on the evening. Which is why I'm suggesting maybe you need to bow out of certain social settings like going out to drinks with your patients.

To be fair, people say that stuff just to pass CS, but then disregard it once they get to practice. That goes for a lot of the "canned saying" they are forced to say to make sure not to fail. Not saying it's right...but yeah that happens.

 

[SpecterGT260]

To be fair, people say that stuff just to pass CS, but then disregard it once they get to practice. That goes for a lot of the "canned saying" they are forced to say to make sure not to fail. Not saying it's right...but yeah that happens.

I'm actually getting the feeling it is going away even in med education. Autonomy seems to trump about everything. Depending on how that gets interpreted you could easily argue against it all together.

 

[Miss Alyssa]

Do you not eat out at restaurants at all? Because you might run into a patient and a patient might see you eating something unhealthy?

Are doctors allowed to have a life outside of medicine? Or is that also not permitted?

That's what I'm wondering reading this thread. I live in a city, but I'm involved enough in the community that I run into people who, while I haven't interacted with them in a medical setting, know that I'm a medical student. I'm sure the same will happen as a practicing physician. I ran into the shoe shine guy while ordering take out at the local greasy spoon. Do I need to concern myself about how I'm some how influencing his diet because he saw a medical person there? Or today when I ran into a former patient at the grocery store?

 

[michaelrack]

That's what I'm wondering reading this thread. I live in a city, but I'm involved enough in the community that I run into people who, while I haven't interacted with them in a medical setting, know that I'm a medical student. I'm sure the same will happen as a practicing physician. I ran into the shoe shine guy while ordering take out at the local greasy spoon. Do I need to concern myself about how I'm some how influencing his diet because he saw a medical person there? Or today when I ran into a former patient at the grocery store?

Psychiatrists actually spend a lot of time learning about stuff like this during residency. Part of it is the stigma of psych illness- when a psychiatrist sees a patient out in a public, the psych is supposed to act like he doesn't know the patient (of course, the psych is supposed to tell the patient that this is the plan) And if a patient were to see his psychiatrist eating in a restaurant, that could take several hours to deal with in psychotherapy (or several seconds of a psychopharm visit).

 

[SpecterGT260]

Psychiatrists actually spend a lot of time learning about stuff like this during residency. Part of it is the stigma of psych illness- when a psychiatrist sees a patient out in a public, the psych is supposed to act like he doesn't know the patient (of course, the psych is supposed to tell the patient that this is the plan) And if a patient were to see his psychiatrist eating in a restaurant, that could take several hours to deal with in psychotherapy (or several seconds of a psychopharm visit).

Why would seeing his shrink in public cause a need for hours of therapy?

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[bestcoast]

Law2Doc, he is not asking the patient out. The patient invited him for a conversation regarding their family history, and he wants to know if he should accept the patient's invitation. Asking out implies a sexual relationship, which is not the case here. As far as we know, its platonic, so I don't really see the problem unless the conversation becomes medical. Now, if there was any implication of romance, that would be a big no-no, but that doesn't seem to be the case here.

On a side note, I have a few family friends as patients. They were actually friends before they became patients. We had them over for dinner at our house last night. As long as we don't discuss anything medical, or go in the direction of romantic/sexual, its fine.

Ya. I discussed it with the attending and he said it was fine.
Nothing sexual and nothing medical will be discussed. I kinda look forward to it because I wanted to call up my grandpa one day and tell him about his former diplomat neighbors haha.

 

[Poetic Silence]

Why would seeing his shrink in public cause a need for hours of therapy?

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Have you ever seen a psychiatrist eating? That stuff will haunt your dreams for the rest of your life.

 

[michaelrack]

Why would seeing his shrink in public cause a need for hours of therapy?

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It doesn't cause an actual need for psychotherapy, it's basically an excuse for the psychodynamic/psychoanalytic (Freudian) therapist to run up the bill. It's something to talk about in therapy other than the patient's mother.

(notice that I said in my post that dealing with seeing your shrink in public would only take several seconds for a biologically-oriented psychiatrist)

 

[SpecterGT260]

It doesn't cause an actual need for psychotherapy, it's basically an excuse for the psychodynamic/psychoanalytic (Freudian) therapist to run up the bill. It's something to talk about in therapy other than the patient's mother.

(notice that I said in my post that dealing with seeing your shrink in public would only take several seconds for a biologically-oriented psychiatrist)

um.... oh....

I thought you were saying that a biologically-oriented psych would just drug them up and leave them.

 

[DrAwsome]

For non-sexual reason?
Today, I met a patient whose parents were neighbors to my grandparents.
They were all diplomats back in the days hence a simple conversation today revealed about this coincidence.

I kinda just want to meet up with him to chat about our ancestries. Patient offered his phone number but I declined. We are both male heterosexual. Is that appropriate to call him up?

Sure, if you don't want to match and/or practice medicine. Of course not. This is even a basic USMLE type question, you cannot have any type of relationship with patients. Too much of a risk and not worth it.

 

[deleted87716]

This is even a basic USMLE type question, you cannot have any type of relationship with patients.

In that case, you'd better go into pathology.

 

[K31]

In that case, you'd better go into pathology.

I took [DrAwsome's post] as sarcasm, but I could be wrong. Of course, my family's FP is a good friend of the family--my parents co-lead a Bible study with him and his wife, we attended his son's wedding a few months ago, etc.

As you said, small towns lead to this type of thing and no one thinks twice as long as it doesn't become intimate.

 

[cabinbuilder]

Sure, if you don't want to match and/or practice medicine. Of course not. This is even a basic USMLE type question, you cannot have any type of relationship with patients. Too much of a risk and not worth it.

I sure hope you are kidding with this statement?? WOW

 

[Law2Doc]

Do you not eat out at restaurants at all? Because you might run into a patient and a patient might see you eating something unhealthy?

Are doctors allowed to have a life outside of medicine? Or is that also not permitted?

You are trying to extrapolate to situations that aren't really similarly situated IMHO. There's a huge difference between running into someone while you are out, and agreeing to go out to drinks or whatever. In one case you are explicitly condoning behavior, by saying "yes let's go out and drink", while in the other, you are at worst a hypocrite. Again, not every situation is necessarily hypocritical -- there's nothing wrong with going out for ice cream if you are healthy, but you may be counseling your obese type ii diabetic not to go down that road -- so in that case it's fine if they see you eating ice cream, but not fine if you tell them, let's go get ice cream. But yeah, if you counseled your COPD patient on the dangers of smoking and he ran into you at a bar with a Camel in your hand, you probably should feel pretty mortified. Again I'm not saying you can't live your life, go out, etc., I'm saying agreeing to go along with a patient socially puts a different spin on it, and you in that setting you never get to remove your doctor hat, because he's always going to see it when he looks at you.

 

[deleted87716]

if you counseled your COPD patient on the dangers of smoking and he ran into you at a bar with a Camel in your hand, you probably should feel pretty mortified.

So, does that mean that fat doctors shouldn't counsel their patients on weight loss? What's your point, exactly?

I definitely think we (the medical community in general) should strive to be role models as much as possible. After all, the best way to lead is by example. However, our lives are our own, and our personal decisions are ours alone. Some things (smoking and obesity, for example) can be as hard for doctors to overcome as it is for their patients. Other things, like occasionally eating high-calorie food or consuming the occasional alcoholic beverage, aren't uniformly off-limits to the general population (especially in moderation, and in the absence of any related medical problems). What's OK for me may not be OK for somebody else. In other words, "do as I say, not as I do."

 

[DrAwsome]

I sure hope you are kidding with this statement?? WOW

I'm not sure what you mean? What's the WOW for????

I don't know what you mean. Romantic relationships between doctors and patients are forbidden. You date/go out with your patients?

 

[DrAwsome]

In that case, you'd better go into pathology.

Way to distort things.
Just need smq123 to comment and it's a reunion.

 

[deleted87716]

I'm not sure what you mean

Yeah...we know.

 

[K31]

Sure, if you don't want to match and/or practice medicine. Of course not. This is even a basic USMLE type question, you cannot have any type of relationship with patients. Too much of a risk and not worth it.

I don't know what you mean. Romantic relationships between doctors and patients are forbidden. You date/go out with your patients?

There's a big difference between romantic relationships and "any type of relationship".