Doctor-Patient Relationships Can Go Too Far Without Going All the Way

A patient wants a friendly doctor, but not too friendly.

Last week, Lisa Zamosky, who writes the Health 411 advice column for the Los Angeles Times, received this note from a reader:

I had a family doctor for eight years with whom I became very friendly. He invited me to parties at his home, and we would meet for dinner and shop together. He once asked to borrow $5,000 to leave his wife. I didn't lend him the money. He later reconciled with his wife, and she forced him to terminate his relationship with me as a friend and doctor. The California Medical Board would not take any action against him, and I found myself without a family doctor. Lesson learned: Be cordial with your doctor, but if you find yourself becoming too close, distance yourself.

She asked me whether this doctor appeared to have crossed any sort of line and what I thought a patient could do in this situation. I had written about every state medical board in the country last year for my Doctors Behaving Badly tour, and I knew from that reporting that boards don't tend to deal with shades of gray. For most medical boards, if a doctor's bedside manner keeps him or her off the bed itself, then no line has been crossed.

When Zamosky contacted the California Medical Board, she was basically told the same thing:

The California Medical Board likely didn't take action in your case because, based on your description, your physician's behavior represents an ethical breach rather than a violation of medical practice, says Jennifer Simoes, the board's chief of legislation in Sacramento. "We have to show that the offense bears some relation to the practice of medicine. We don't police physicians' private lives," she says.

Sexual relationships, however, are against the law and would prompt the board to take action, she adds.

But boards are too quick to dismiss complaints like this one. As I told Zamosky, the reason that sexual relationships are forbidden is because they can cloud a doctor's judgment and because they can be predatory – even subtly so – because the doctor holds a position of power. I have interviewed numerous women over the years who went out on dates with doctors, some of whom even had sex with their doctors in the doctor's office during visits. All of them felt tricked, even though they knew that they had gone into the relationship willingly. In some cases, they described being hypnotized by the way the doctor understood everything about them, biologically and emotionally. That level of understanding is hard to find just meeting people in a bar.

If you take the sex out of the relationship, the power dynamic still remains and the cloudy judgment still remains. This is why situations like the one the reader described should be considered warning signs – both for patients and for medical boards. If you read a lot of medical board documents, you will see scenarios like this one described, usually accompanied by loose prescribing of dangerous drugs, insurance fraud, medical errors or other problems.

Dr. Harrell Robinson, for example, persuaded a patient to loan him $90,000. He had a string of botched surgeries and helped set up a false-front clinic to shell out painkillers until the California Medical Board and the U.S. Drug Enforcement Agency finally caught up with him.

The next time your doctor asks you if you want to go see a movie or a football game together, think twice.

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