1. The ethics of doctor-patient relationships and friendships
2. Hospitals buying awards they don't deserve
Q: I am a female nurse (RN). I wanted an opinion for a scenario similar to the patient/surgeon possible attraction. I have been seeing a medical doc (not surgeon) for a particular injury for the past few weeks. The thing is, I also had a professional relationship with him a few years ago. Suddenly I find myself becoming very attracted to him, and during my last visit, he smiled and kept eye contact constantly for approximately 10 to 15 minutes and I did as well—this after telling me that I looked fantastic. I wanted to get your opinion on how to interpret this.
Answer by Kevin Pezzi, MD: The smile means little in itself. However, when coupled with the compliment about your fantastic appearance and especially the 10 to 15 minutes of constant eye contact (that is an eternity in modern medical practice!), it is obvious that he is attracted to you and likes you—the two are not the same, since it is possible for men to be physically attracted to women they don't like.
Q: I would not consider asking him out, as I would not want to put both of us in an awkward situation. Also, does the AMA code allow for getting together as friends initially while still treating, so that you could determine both parties true feelings down the road, and discontinue treatment?
A: Excellent question. When the AMA and state medical boards enact guidelines governing relationships between doctors and patients, they seem to assume that all such relationships are romantic or headed in that direction. This is an antediluvian stance that gives us insight into just how far behind the times they are, and how little they think of women. The tacit message is this: The value of a woman to a man stems from her breasts and vagina. If a man has no sexual access to those portions of her anatomy, the AMA and state medical boards assume that a doctor would not want to be friends with her. This sends a damaging, insulting, and misogynic message to women: other than the sexual portions of your body, men have no legitimate interest in you as a person.
Every knuckle-dragging caveman knows that relationships with women aren't worth pursuing unless they offer sex. A woman's brain, interests, opinions, hobbies—none of that matters. If a man can't get a woman in bed, why on Earth would he waste his time with her? Since every caveman knows this, it logically follows (to simpletons, at least) that when a male doctor has a relationship with a female patient, it MUST BE for sex.
I've had purely platonic friendships with many women. We could talk for 15 hours per day for three days straight and didn't need chains or some AMA nitwit to keep us out of the bedroom. The friendship was just that, and nothing more.
The AMA and state medical boards seem intent on demonstrating not just how little they think of women but also on their amazing ignorance of law. Yes, I know: People who serve on medical boards probably get a thrill up their legs from puffing their chests out as they dictate to others what they will and will not do. Just one problem: courts have ruled that the constitutional right to privacy protects sexual autonomy and everything related to it, including dating and marriage, for everyone, including doctors. If it protects sexual autonomy, it surely protects the constitutional right to privacy in terms of being friends with whomever you choose.
Another point: My opinion of the AMA plummeted after it sided with Obama instead of doctors and patients who don't want government-run healthcare or anything close to it. Like most doctors, every year I receive a solicitation from the AMA to join it and pay its outrageously excessive dues. Like most doctors, I process that letter by tossing it in the trash, where it belongs. In my opinion, and the opinion of most American doctors, the AMA does what is best for the AMA, not doctors or patients. The AMA is just one of the many enemies that doctors must combat as they try to deliver the best possible care for the least possible cost. With “friends” like the AMA, who needs enemies?
ObamaCare could have been great. It could have saved people piles of money and delivered much better care, but it didn't. I never expected that President Obama, not being a doctor, would see how to achieve this; the AMA could have helped educate him, but they didn't.
Q: Also, is there anything in the rules about parties that have had a professional relationship prior to the treating relationship?
A: I've had friends show up in the ER when I was the only doctor on duty. What was I to do? Deny treatment to them? Immediately end our friendship? If I were engaged to a woman and she became my patient in the ER, should I cancel the wedding and shun her forever?
It isn't practical (or legal, given the constitutional right to privacy) to insist that doctors terminate existing friendships if a friend is given medical treatment. I've given medical treatment to both of my brothers and saved the life of one after he saw four doctors (ER and family practice docs and a neurologist) who evidently didn't know as much as they should. So what should I have done? Refused to treat my brother with the serious medical problem and wished him well in finding a doctor who wasn't a quack? (I will continue this topic at the end of this page.)
Ultimately, the concern about doctors becoming romantically involved with patients stems from a fear that some (very few, I think) physicians might use their power to coerce patients into having relationships they don't want or doing things they don't want in exchange for something they DO want. For example, I've had some very beautiful patients in the ER who offered to sleep with me in exchange for a narcotic prescription, and one even offered to pay me in addition to the sex! (I described this case in my blog.) If you saw how incredibly beautiful she was, you'd probably wonder how I could possibly reject her offer, but I did. I didn't go to medical school to put a veneer of legitimacy on being a drug pusher, nor did I become a doctor to receive sexual favors from women who make Hollywood actresses look like Plain Janes. If a person has a conscience and a good sense of what is right and wrong, it takes only a split-second to reject such an offer, no matter how tempting it was.
Here is a relevant excerpt from my free book, From Bailout to Bliss:
After Illinois Governor Rod Blagojevich was arrested for conspiring to sell or trade the Senate seat vacated by President-Elect Obama, a political analyst said on television that “we're all corruptible.” I disagree. For example, consider the supermodel I mentioned above. Trust me, there is nothing that men want more than women with whiplash-inducing beauty. I wasn't dating anyone at the time she offered to sleep with me in exchange for prescription narcotics**, nor had I dated anyone in the preceding two years.
** Perhaps assuming that her request for drugs might lead me to assume that she had possibly used illegal ones that might heighten her risk of HIV or hepatitis, she was savvy enough to mention that she never used such drugs, assuring me that I could enjoy what she had to offer without contracting any diseases.
Physically, I wanted her about as much as a person wants a glass of water after three days in a hot desert without drinking, but no amount of physical temptation could reverse my “no” decision. She also offered to pay me a surprising amount of money. My answer was still the same: no. This visibly annoyed her, because she couldn't understand how any man could resist her. She was one of those women who are beautiful, cute, and sexy, with an impossibly perfect body, so I could understand why men found her irresistible—something she felt the need to explain to me, after seeing that I wasn't responding to her in the way she wanted. I've had other very attractive women make similar offers, but I turned them down, too.
It would have been so easy to “justify” those narcotic prescriptions. (See the dialogue between an UNETHICAL MD and a BEAUTIFUL DRUG-SEEKING PATIENT).
There are some things you just don't do, regardless of the inducement. If someone offered you $100 billion to kill your mother, you'd tell him to go jump in a lake. So are we all corruptible? Obviously not. This “everyone has their price” excuse is just a way for people with defective moral compasses to justify their behavior.
This is not the patient who offered to sleep with me in exchange for narcotics; this is just
the hottest model I could find today. As hot as she is, my patient was even more attractive.
If you become a doctor, you will now have some idea of the temptations you will face.
You don't need the power of a doctor to coerce people into having sex. No good person who lives by The Golden Rule (a.k.a., the ethic of reciprocity) would use his or her power to pressure others, but some people are unprincipled enough to do that. A few years ago, I met a woman who was amazingly attractive and willing to reveal damaging things, such as the fact that she made quite a bit of money but never bothered to pay income taxes or even file the required returns. No matter what you think about the IRS or the excessive taxes we pay, it is just plain stupid to not pay what you owe. She was eager to sleep with me (I rejected her offer because of something unrelated to her appearance and lack of common sense), but what if she told an unprincipled man about how she never filed tax returns? If she did not want a relationship with him, he could use that info to blackmail her into having sex.
I think most doctors would bend over backwards to NOT coerce, blackmail, or otherwise pressure anyone, especially patients. I therefore take offense when the AMA and state medical boards tacitly suggest that doctors should erect walls between themselves and patients out of a fear that coercion may be used to pressure patients. Blackmail is already a felony for everyone, so why is there a need to create unconstitutional rules that try to limit what patients and doctors can do? The real crime is the coercion, not the friendship or relationship. If the friendship or relationship includes no coercion, there is no victim and hence no crime.
My biggest regrets pertaining to me giving medical treatment to my family is that I didn't do more. For example, when my Mom developed intense back pain, I was too patient in waiting for the quacks at her local hospital (supposedly one of the Top 100 Hospitals in the nation, which is about as legitimately true as saying that I am one of the Top 100 hunks in the country) to realize what was obvious to me: THIS WAS NOT TYPICAL MUSCULOSKELETAL BACK PAIN! After she saw a couple docs who proved to me that they didn't deserve to put "MD" after their name, I ordered an MRI scan that showed exactly what I feared: metastatic cancer.
That lesson should have taught me how unwise it was to trust the nitwit doctors at that hospital, but I had not yet fully realized how such a supposedly topnotch hospital could be staffed by so many incompetent people. They didn't put her IV in a vein, nor did they detect that it wasn't in a vein! The biggest shock of them all came after my Mom complained of vaginal pain. Since she had bladder cancer, this could be a problem directly related to the cancer, or it could be an unrelated problem. While speaking with my Mom's doc on the phone, I asked her if she'd performed a pelvic exam to determine the cause of that pain. She said that she had not, and then suggested that I do it! As if!
A few years later I went to the lab at that hospital to have a couple of tests performed. I was shocked to find that the phlebotomist at this Top 100 Hospital did not know how to draw blood correctly! Then this hospital killed one of my friends with their incompetent treatment, and other friends who worked there told me of many other botched cases. I was horrified watching one of their techs perform a transvaginal ultrasound.
For that hospital to brag about being one of the Top 100 Hospitals in the nation is like Oprah claiming to be a fitness model. I was so incensed by their unwarranted claim to greatness that I spent a couple months digging into this award and ones like it. In the end, I concluded that most such awards are scams in which hospitals buy the awards they want. The cash transfers are cleverly disguised to conceal the nexus between the award and the payola that bought it.
During my investigation, I also found a supposedly prestigious nursing organization that offers awards to hospitals that can afford them. The leaders behind that award couldn't spell very well, nor were they smart enough to conceal their greed. They did not come off as a professional organization but as a bunch of greedy teenagers just salivating for the chance to get their hands on more money.
I don't know of anyone who has done more to investigate how hospitals buy awards, so contact me if you want to read my report once I complete it. If you use my track-this.info site to track (follow) updates to various topics, you can click the following link or orange button so that you will be instantly notified once my report is available:
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