Is it ethical to date former patient you discharged from the hospital?

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coolcicada

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I am an internal med resident and treated a patient in the ICU for 3 days. She recovered well and got discharged. Then I went on to cardiology for my next rotation and one of my colleagues said unfortunately she was readmitted a few days later for another condition but I was not involved for this second admission. She then got discharged again from the hospital. I never seen this patient before outside the ICU and she don't follow up with us for outpatient. A few weeks later, I was looking for housing and the person who helped us in person happens to be this former patient. We got along well and she is interested to develop a relationship, but I am not sure whether it is ethical. She has no psychiatric conditions.

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If anything, I think it would be best to not pursue a relationship until there is a 0% chance you could be involved in that patient’s medical care in the future. I would also want to put quite a bit more time between pursuing that and when you saw her in the hospital.
 
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Fascinating question! I may use this in interviews. At first glance, I thought it would be OK, but the wise VA Hopeful's comments made me want to investigate this.

Here's what the AMA has to say:

A physician must terminate the patient-physician relationship before initiating a dating, romantic, or sexual relationship with a patient.

Likewise, sexual or romantic relationships between a physician and a former patient may be unduly influenced by the previous physician-patient relationship. Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship, or if a romantic relationship would otherwise foreseeably harm the individual.

In keeping with a physician’s ethical obligations to avoid inappropriate behavior, a physician who has reason to believe that nonsexual, nonclinical contact with a patient may be perceived as or may lead to romantic or sexual contact should avoid such contact.



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A British take:
 
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There is at most a handful of potential mates in your city you shouldn’t be messing with because of you job, they are one.
 
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Fascinating question! I may use this in interviews. At first glance, I thought it would be OK, but the wise VA Hopeful's comments made me want to investigate this.

Here's what the AMA has to say:

A physician must terminate the patient-physician relationship before initiating a dating, romantic, or sexual relationship with a patient.

Likewise, sexual or romantic relationships between a physician and a former patient may be unduly influenced by the previous physician-patient relationship. Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship, or if a romantic relationship would otherwise foreseeably harm the individual.

In keeping with a physician’s ethical obligations to avoid inappropriate behavior, a physician who has reason to believe that nonsexual, nonclinical contact with a patient may be perceived as or may lead to romantic or sexual contact should avoid such contact.



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A British take:
It came up in an early ethics small group when I was in med school. The tricky issue was if you're literally the only doctor in a given area. Everyone could be your patient, so the rules get a little more lenient.

No IM program is so rural that this exception would apply. There's likely a good sized city worth of single people you haven't doctored for to choose from.

If you insist on pursuing this (and I wouldn't if I were you), make sure a decent period has elapsed (6 months I'd suggest at minimum) since you last cared for this person and make sure you never do again.
 
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Thank you guys for the advice! My program is rural even though it is IM. Our main hospital has less than 100 beds and it seems most of the people know each other. The town the hospital is at has less than 4000 people in terms of population. The outsiders are our residents who are mostly from out of state. I was thinking about talking with my program director about the situation since she is laid back and seems to open to help our residents.
 
I was going to recommend that next step exactly. This falls into a grey area. If you were still caring for her (i.e. she was in your clinic) or if your care of her extended over a long period of time, then it's a solid no. But this is a patient you helped care for a few days, with supervision in an ICU. You have no ongoing clinical relationship with her. Hence, in my book, I think you could pursue this if you want although you do need to be careful, and getting your PD's input will be helpful.

I will add several important issues:

1. Starting immediately, no matter what you do / what happens, you can have NOTHING to do with her ongoing care unless it's an emergency and you're the only option. Even if you decide not to pursue this, you can't care for her anymore. You should not answer her medical questions nor should you try to "help" fix any problems that might occur (i.e. she needs an appointment, or having trouble getting a refill, etc).

2. You mentioned that she was admitted for something else. Hopefully, you did not log into the EMR and review her chart. If you did, this makes dating her riskier if things go badly.

When considering something like this, the best way to look at it is to assume the worst. Assume that you date her, things get super ugly, she dumps you. You want to make sure that your actions can't be interpreted as abusing your position. So any of the following would make me worry:
A. If as part of your care of her you needed a social or sexual history and now know something "secret" about her.
B. You performed a vaginal, rectal, or breast exam on her, or any other exam that would be considered invasive.
C. You reviewed psychiatric notes in her chart

Even without any of this, if this relationship becomes ugly it could blow back on you because there's always some privacy boundaries that physicians cross (appropriately) when caring for patients.
 
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Participating in their ICU care would make me wonder if there was an element of hero worship factoring in to the feelings and I wouldn't think it ethical to exploit that. Not something I would consider worth the potential bad fallout if things go poorly even if it was considered ethical.
 
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Participating in their ICU care would make me wonder if there was an element of hero worship factoring in to the feelings and I wouldn't think it ethical to exploit that. Not something I would consider worth the potential bad fallout if things go poorly even if it was considered ethical.

Especially if you're a resident and thus have something big to lose (getting kicked out of your program).

OP: you can be friends with her first, take things slow.
 
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Especially if you're a resident and thus have something big to lose (getting kicked out of your program).

OP: you can be friends with her first, take things slow.
No one needs friends that bad, find one that isn’t a patient
 
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My state has laws against dating patients for either 2 or 3 years after you terminate the patient-physician relationship. The laws here don't delve into the nuances of the relationship though, so it's really not clear if you were only shortly or slightly involved in their care whether you would be held responsible legally to the same extent if a complaint was made against you.
 
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My 2 cents:

I agree with a above that probably 95% of people that get admitted to a hospital twice in 30 days at age <30 are outliers in a bad way (I admit this probably isn’t true and due to recall bias).

Any LAW stating some minimum time before two otherwise consenting adults can date is pretty preposterous imo. Is there a similar law against dating firefighters or EMTs?

Asking if this girl is pretty enough is the wrong question. There is no girl (or boy) pretty enough to risk your career on, period. Not to mention it you lose your career you might find said person mysteriously less interested in the first place.

Be friends with this girl at your own peril and talk to your PD if you absolutely must. If you opened her chart during admit #2 I would delete her phone number and find a different apartment. If you truly live in an area with a population of 4,000 then I sympathize with you and wish you the best whichever you choose. If it does end up blowing up please do us the courtesy of coming back and making a thread about it!
 
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This
Participating in their ICU care would make me wonder if there was an element of hero worship factoring in to the feelings and I wouldn't think it ethical to exploit that. Not something I would consider worth the potential bad fallout if things go poorly even if it was considered ethical.

Followed by

No one needs friends that bad, find one that isn’t a patient

If you had met her 2 year later and then 4 weeks into dating worked out that you had cared for her for a few days that would be one thing, but that's not what happened. The fact that you both recognized each other means that the foundation of your relationship is inextricably tied in with the doctor/patient relationship. I mean, you entered the game knowing her H&P, smoking/drug/ETOH history, bladder/bowel routine, overnight events, family support system, and discharge plan. Reinterpreted through a dating lens, you've already gotten to second base if you've auscultated her. I'm sorry but that's too much of an edge to have over someone you might start a relationship with. She should know better too. It's fine for her to admire your competence, bedside manner and square jawline but wanting to date someone on her care team speaks to impressionability and immaturity. Proceed with extreme caution.

Dating in med school/residency can be hard but REALLY, REALLY ask yourself if you're pursuing her because you are lonely and already have a head start. Listen to your conscience and your brain, leave your heart out of this one.

Good Luck
 
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Fascinating question! I may use this in interviews. At first glance, I thought it would be OK, but the wise VA Hopeful's comments made me want to investigate this.

Here's what the AMA has to say:

A physician must terminate the patient-physician relationship before initiating a dating, romantic, or sexual relationship with a patient.

Likewise, sexual or romantic relationships between a physician and a former patient may be unduly influenced by the previous physician-patient relationship. Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship, or if a romantic relationship would otherwise foreseeably harm the individual.

In keeping with a physician’s ethical obligations to avoid inappropriate behavior, a physician who has reason to believe that nonsexual, nonclinical contact with a patient may be perceived as or may lead to romantic or sexual contact should avoid such contact.



.



A British take:
Unless you're a psychiatrist, then it's a hard no always and forever
 
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From what I've heard about docs who have relationships with previous patients, the relationship usually goes on fine but the problems come once you want to break it off. That's when the complaints to employers, state medical boards, and certification boards come...

inb4 "that'll never happen to me"
 
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Too risky... I would not do it.
 
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Even if it is ethical, and legal, it is still a VERY VERY VERY bad idea.

Not sure what year resident you are, but given IM you will be moving on in 1-2 years, and that (if not before) is when things will likely go south.

Will you give up a job in another area of she doesn’t want to move?
Will she move with you thereby maybe making things more “serious” than you want to be?

These Qs are not unique to this relationship, but the total ****show she can create for you when (NOT if) it is over is never ever worth it.

Do NOT talk to your PD since this info can be used against you later in any (unrelated) professionalism claim.

DON’T do it (or her).
 
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If she's in the iCU twice already at a young age I would consider her reliability in the Long run. Even if she's hot sounds like her check engine light might stay on a lot (read Land Rover)
 
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OP I look forward to your inevitable future post where you ask for advice after the state board takes some sort of action against your license.

As some of my fellow shrinks have said above, for us it's a lifetime ban. I honestly feel like it should be that way for any type of physician.

Once you establish a physician-patient relationship, you can't just 'unmake' it and establish a romantic relationship. No more than you can turn it into a friendship, a business relationship, or whatever.

Recently I have had numerous calls from prospective patients saying their current psychiatrist is taking a 'temporary leave' because he had an 'elective surgery' that 'didn't go well' and he 'needs time to recover'. Guessing this was probably a lie, I looked up this guys license on the state board website.

I was correct. Not only did he have some sanctions from sleeping with his clinic patient while he was a resident, he again, a few years out of residency, basically did what you are proposing, with a patient he saw on a consult service. They dated for several months then after they broke up she reported him to the board.

Accepting the small risk that he will try to murder me for doing so, I called the board to let them know he is lying to his current patients as to the reason he is no longer able to continue practicing.

Also consider that many states are now passing laws that actually criminalize this behavior as sexual assault or battery.
 
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OP: You are a single physician in a small town. Welcome to trophy husband territory. Big fish, small pond. If you haven't already, you'll see numerous random friend requests as well as other friendly/flirtatious smiles at the hospital. Tread VERY CAREFULLY.
 
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OP, you are insane if you're planning on dating a former pt, even under those circumstances. Regardless of whether it is allowed by the state medical board which is nothing more than a technicality. It just LOOKS bad. Also, this person has the potential to straight up GTA5 WRECK your career. You could get reported to the medical board and investigated and regardless of the findings you would have to forever report that. You could get reported to the hospital and might get fired or suspended pending an equally uncomfortable investigation. We had an ICU doc investigated like that a few years back and the only work he could get in town was a SNF.

The whole thing screams psych. You've worked way too hard to get where you are in life to risk throwing it away over a fling with a pt. Google Florence Nightingale syndrome and make sure that's not you. Don't ever give someone that much power over your career and life. Ever. I'm sure there are PLENTY more non patient girls in your area that would be happy to date you.
 
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Just think of her as either a felon, murderer, clinically insane, married, shameless golddigger, or having six kids (or some combo of the above). Should help you nope out of situation pretty quickly. Usually works for me.
 
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There’s other fish in the sea. Go for some farm raised salmon instead of wild Coho.
Coho is a wild caught salmon off the coast of Alaska. It’s fat content is thought to be superior to farm raised salmon in terms of benefits derived from fatty acids. The less wild, farm raised salmon provides enough of these fatty acids but some feel there is more benefit to the coho with increased risk: Mercury, is it really salmon?, depleting the ecosystem.

Although I’d advocate the Coho routinely to patients, in this case with the farm raised providing a good amount of what you need, the risk isn’t worth it.

In this case, when thinking of dating a prior patient, go with another fish in the sea that fulfills relationship goals that isn’t wild.

I had to go way more in depth with this than I was expecting, haha.
 
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Coho is a wild caught salmon off the coast of Alaska. It’s fat content is thought to be superior to farm raised salmon in terms of benefits derived from fatty acids. The less wild, farm raised salmon provides enough of these fatty acids but some feel there is more benefit to the coho with increased risk: Mercury, is it really salmon?, depleting the ecosystem.

Although I’d advocate the Coho routinely to patients, in this case with the farm raised providing a good amount of what you need, the risk isn’t worth it.

In this case, when thinking of dating a prior patient, go with another fish in the sea that fulfills relationship goals that isn’t wild.

I had to go way more in depth with this than I was expecting, haha.
Your response sounds fishy to me, but I'll admit that you've got me hooked.
 
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If she's in the iCU twice already at a young age I would consider her reliability in the Long run. Even if she's hot sounds like her check engine light might stay on a lot (read Land Rover)

Lol this is too true. If your loved one hits the ICU a few times, of course you continue to love them. But persuing a young woman with multiple ICU admissions? Ahhh no

But of course that little detail is completely irrelevant because if she was a patient of yours the answer is hell no. We don’t need to understand the details..
 
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I am an internal med resident and treated a patient in the ICU for 3 days. She recovered well and got discharged. Then I went on to cardiology for my next rotation and one of my colleagues said unfortunately she was readmitted a few days later for another condition but I was not involved for this second admission. She then got discharged again from the hospital. I never seen this patient before outside the ICU and she don't follow up with us for outpatient. A few weeks later, I was looking for housing and the person who helped us in person happens to be this former patient. We got along well and she is interested to develop a relationship, but I am not sure whether it is ethical. She has no psychiatric conditions.
Did you get a good housing deal?
 
I'd say go for it but I think you are a little too preemptively certain that she has no psychiatric issues....
 
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Just nah man. There's only a few things i've ever heard residents (in real life, not online) get fired for. Dating a patient was one of them.

Don't cross that line man.
 
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You are an adult. You can make your own decision. If you are willing to take the risk, and you think its worth it then go ahead. Just know what risk you are taking and how it can change your life.

You are still a lowly resident thus your risk is much higher than a practicing doctor. Resident kicked out of their program is much worse than a practicing physician being sanctioned by their board.

So back to my analogy.

Do you like to ride a motorcycle? You could be the most careful rider but there are potholes and distracted drivers around you that you have zero control over. If said distracted driver gets into your lane or runs a stop light, then you could die/badly injured.

Same thing goes for this relationship. You can be as careful as possible but only takes one Bat Crazy girl to turn your life into hell with accusations of improprieties or using your past medical relationship against you. Don't underestimate a jaded girl, I have seen worse.

Now if you think this girl is worth your medical license/career then sure why not. For me, NO girl that I barely know is worth it. I don't know why people like added drama in their lives.

BTW, did you help repair her bilateral wrist lacs or order the Charcoal? Did she have poison control on her speed dial? :)
 
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It's in their nature, man. We can't help what is ingrained in us, like the grain of the wood.
Well if we can get un-ingrained we all would be much happier. Its like a hot stove. If I see drama, I do not touch.

Hot Nurse. Nice to look at but would never touch
Hot patient. nice to look at but would never touch
Political discussion. Fun to discuss but would never touch
Religious discussion. Would not touch
Covid discussion. Would not touch
Racism - would not touch.
Hot stove - would not touch
 
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Well if we can get un-ingrained we all would be much happier. Its like a hot stove. If I see drama, I do not touch.

Hot Nurse. Nice to look at but would never touch
Hot patient. nice to look at but would never touch
Political discussion. Fun to discuss but would never touch
Religious discussion. Would not touch
Covid discussion. Would not touch
Racism - would not touch.
Hot stove - would not touch
Agree with almost all except for the 'Hot Nurse.'
 
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To the OP, seems still somewhat too early to consider dating this former patient. Prior to anything, I would consider discussing this with the PD at your residency for his/her blessing in regards to this. Last I would ever want is the PD to find out about this after the fact.

In regards to dating nursing, I found it much easier as long as your not working their floors anymore and your genuinely interested. I did this myself with an amazing Labor/Delivery floor RN after my FM OB rotation during intern year. She was in the middle of working on her CNM degree so we were both somewhat busy. I didnt ask her out to the last week of my rotation. Year or so later we ended up engaged and will be getting married shortly if COVID allows lol....

Be smart, be honest, and if it feels wrong in your gut, don't do it.
 
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Well if we can get un-ingrained we all would be much happier. Its like a hot stove. If I see drama, I do not touch.

Hot Nurse. Nice to look at but would never touch
Hot patient. nice to look at but would never touch
Political discussion. Fun to discuss but would never touch
Religious discussion. Would not touch
Covid discussion. Would not touch
Racism - would not touch.
Hot stove - would not touch
1601399351438.png
 
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Doctor-Nurse relationships are risky. I've seen success stories ending in marriage & kids and situations where it exploded. It tends to boil down to whether the doc was genuinely interested or just looking to hook up. Nobody wants to feel used and the scorn is compounded by the doctor/nurse authority differential (which ironically may have added to the initial attraction on both sides).

As a doc I can see plenty of reasons to date an emotionally stable and professionally content nurse but you play a high stakes game if you date within your hospital. This goes for dating within your residency class or attending pool too. The same rules and caveats of and office romance apply but with 80+ hour work weeks and a professional reputation to consider.
 
Well if we can get un-ingrained we all would be much happier. Its like a hot stove. If I see drama, I do not touch.

Hot Nurse. Nice to look at but would never touch
Hot patient. nice to look at but would never touch
Political discussion. Fun to discuss but would never touch
Religious discussion. Would not touch
Covid discussion. Would not touch
Racism - would not touch.
Hot stove - would not touch
Some hot stoves are nice to look at!
1601488353179.png
 
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I'm not advocating for dating a patient, but I don't think you guys understand how commonly this happens. I know of physicians not only dating patients but having extra-marital affairs with them! Granted, it's in smaller towns where you are less likely to get in trouble.

Honestly, if someone was your patient at one point and you no longer have any kind of doctor patient relationship, I really don't see a problem. Yeah, you have to be extra careful and I definitely wouldn't do it while in residency - your program will hate the liability and then possibly fire you if HR/legal finds out about it. After training...much less risky...
 
I'm not advocating for dating a patient, but I don't think you guys understand how commonly this happens. I know of physicians not only dating patients but having extra-marital affairs with them! Granted, it's in smaller towns where you are less likely to get in trouble.

Honestly, if someone was your patient at one point and you no longer have any kind of doctor patient relationship, I really don't see a problem. Yeah, you have to be extra careful and I definitely wouldn't do it while in residency - your program will hate the liability and then possibly fire you if HR/legal finds out about it. After training...much less risky...
You know multiple physicians in multiple small towns having extra-marital affairs with patients and you are ok with this because:
1. Small town less likely to get into trouble
2. No longer Dr. -Pt relationship
3. Done with training so less risky
4. they are extra careful

Sorry I think I may have read this wrong?

Scenario just for fun:
Dr. YS: So Ms. Johnson labs look good and I will see you back.........never because I just ended our Pt.-Dr. relationship.
MS. J: What?
Dr. YS: Yes, we won't just be dating... because you know... I'm married!
Ms. J: What???
Dr. YS: Look I know, I know and its ok. I'm finished with training, extra careful, and we do live in one of the smallest towns ever!

just having fun
 
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