The Lovelorn Patient

A sympathetic ear, or simply being heard, can often trigger an emotional response from a patient. Whatever the reason, the potential blurring of the doctor–patient relationship can lead to significant professional consequences if not managed promptly and appropriately.

Case study

A female patient in an abusive relationship always saw a female doctor in the practice. She was booked with a male doctor at short notice after her usual doctor left to deal with an emergency. The male doctor was sympathetic towards the patient who had been verbally abused by her partner the previous night.

The patient’s usual doctor returned from leave, but the patient continued to book with the male doctor. The frequency of the visits increased and the patient asked the doctor for his mobile number in case of emergency. He provided it, concerned about the patient’s previous history of domestic violence.

The patient didn’t use the number until late one night when he received a text:

The doctor was very concerned, and he was unsure what to do. His wife, also a doctor, urged him to contact MDA National for advice.

Discussion

In hindsight, the doctor was able to recall the warning signs. The patient didn’t need to attend so often. She always booked his last appointment for the day and spent much of the consultation engaging him in conversation. The doctor was aware she was vulnerable and didn’t know how to raise the issue without causing her distress. Once he received the text, he realised the doctor–patient relationship was unhealthy and that he would need to end the therapeutic relationship.

A medico-legal adviser assisted the Member to write to the patient, stating it was in her best interests to find a new doctor or practice.

Due to the risk of repercussions if the letter was opened by the patient’s partner, it was agreed that the doctor would explain the situation and provide the letter to her in person. The patient was embarrassed and she opted to move to another practice.

Things to remember

• Doctors may feel responsible for the patient developing feelings towards them, but this is not usually the case. Over time, boundaries can blur gradually and subtly.
• It may seem easy to continue to see the patient rather than address the issue – but if warning bells are sounding, seek advice about ending the therapeutic relationship.
• The lovelorn patient is often vulnerable and should be managed sensitively. ‘Firm but kind’ is usually the best approach, as the patient may feel hurt and embarrassed when their advances are rejected.
• Embarrassment or naivety in these circumstances is understandable, but will carry little weight with AHPRA if it becomes clear that professional boundaries have been breached and the doctor has not dealt with the matter in a professional and timely manner.
• Keep your professional and personal life separate, e.g. don’t accept friend requests from patients on Facebook and avoid discussing your personal life during consultations.
• Doctors sometimes continue the therapeutic relationship, fearing that the patient will make a complaint if they end the relationship. In our experience, we find that the risk of a complaint increases the longer you continue to see the patient.
• Return any gifts, but keep a record of text messages (as screenshots), emails, letters or cards in a separate medico-legal file.

If the therapeutic relationship is causing you concern or no longer healthy, please contact our Medico-legal Advisory Services team for advice on how to manage the situation.

Nerissa Ferrie
Medico-legal Adviser, MDA National