This summer, Sansone and Sansone published Crossing the Line: Sexual Boundary Violations by Physicians in Psychiatry (Edgemont) 2009(6): 45-48. They reviewed public Board actions against doctors for such violations. They also reviewed studies of questionnaires sent directly to doctors. Not much had previously been written on the topic.

Regarding Board actions: Sansone focused on a handful of states. Prevalence was calculated based on the number of published disciplinary reports highlighting sex divided by the number of licensed doctors in that state. Using that metric, the prevalence varied from 0.04% to 1.6%. Pretty low.

Now to directly questioning doctors. Four US based studies made the list. The prevalence varied between 3.3% and 9.3%. Just for comparison sake, our overseas colleagues are even more “active.” A small study of non-psychiatric physicians in Israel established a prevalence of 14.5%.

Why the disparity? Board action first requires an unhappy person reporting a Complaint. Many such relationships are consensual, even if they may not be considered ethical. A consensual relationship will likely not trigger a Complaint to the Board – unless the relationship ends as a surprise. (Such as “By the way, did you know I was married”….” or “I cannot refill your prescription any longer, and by the way, did you know I was married.”)

Next, even unhappy patients may not want their privacy violated with a near-certain Board investigation. They may view such an investigation as uncomfortable, shameful, or even a second violation. Hence, they just let it go.

Interestingly enough, if you concluded that only male physicians are dating their patients, you would be wrong. In a study of two specialties, only 86% of those admitting to a relationship with patients were male.

A number of physicians have done it by the book. That is, they formally terminate the doctor-patient relationship first. The patient then seeks follow-up care with another provider. Then a sexual relationship begins. Perhaps it is not always so linear, but, many doctors recognize that if the Board investigates a Complaint, it will be better to demonstrate that the other party is/was a “former patient.”

Some argue that physicians should never have any sexual relationship with even a former patient. Such a broad rule may have unintended consequences. It is true that in the context of a doctor-patient interaction, patients are vulnerable. For a doctor to properly treat a patient, he/she must be told a great deal of personal information, including secrets the patient would never share with anyone else.

But, what is a rural doctor to do? He/she might be the only practitioner for miles around. Is that doctor foreclosed from any bond of intimacy? Can that doctor never date if he/she has taken care of every person in the community? Not an easy answer when viewed in that context.

What do you think?