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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


Patient attracted to her surgeon

Q: Dear Dr. Pezzi,

I truly enjoyed reading your response to an inquiry on your ER doctor website, entitled: Patient attracted to her doctor; doc seems interested. Can they date?

I enjoyed it because the writer tells a story similar to my current experience. I had an accident resulting in near amputation of my finger. I was without medical insurance and money. After several rejections from other doctors’ offices, this surgeon accepted me, offered payment arrangements and made it possible for me to pay the bill off.

From the beginning, he behaved as if he felt honored to help me. I told myself I was hallucinating from the morphine shot given to me in the ER the previous day. After the surgery that reattached my finger, I saw him every week for a month. During these visits I noticed he seemed to spend more time talking to me about my condition, demonstrating PT techniques, going over paperwork, etc. I began to notice he seemed a little shy, like the way a little boy behaves around a little girl he likes. I began to recognize the chemistry but dismissed it thinking it was just my gratitude towards him for helping me or some form of transference.

Before I made my first payment on my bill, the receptionist whispered in my ear that the doctor had cut his fee in half and offered to match anything I paid by deducting the same amount from the balance on my bill. When I asked her “why,” her response was, “Ask him, maybe it’s because you have no health insurance.” A month after the surgery, he agreed to wait until my lawsuit was settled to be paid. I felt overwhelmed by the quality of care, his compassion, humanity, and generosity.

After the fourth post-surgery visit, he seemed to make more eye contact or maybe I just paid more attention. Either way, he seemed to be looking deeper and steady into my eyes, as if he wanted to hug me as he said, "Everything would be alright," but I dismissed it as my imagination.

During what I thought would be my last visit (and subsequent end of our patient-doctor relationship), I was surprised when he said to come back in eight weeks after my PT ended. This made it awkward because I came prepared to give him a bottle of wine as a gesture of my gratitude, gift wrapped with a note inside inviting him to a dinner party with friends including an acquaintance who happens to be a surgeon. The note also said he has an open invitation for dinner at my place. I am sure he read the note after I left his office.

When I gave him the gift, he seemed absolutely stunned. He looked at me puzzled and said, “You did not have to do this.” He said this twice which puzzled me. The second time he said it I responded by saying, “Yes I did,” in a loving but slightly defiant tone. Then he shocked me by giving me a full body hug, which completely threw me off. After the hug I did not know what to do so I asked him for a second PT referral. I could tell he was nervous as he wrote on the form plus he forgot to add instructions and asked for it back so he could correct what he wrote. (No worries, the nurse is always in the room as the chaperone).

I don’t know if he is married. I suspect he is in his 40s or 50s. He does not wear a ring but that does not mean anything.

Surgeons seem to have a peculiar attraction to me. One surgeon became physically (and visibly) excited once he rubbed my leg during an examination—and no, I never came on to them, no flirting, nor did I behave or dress provocatively.

I have another appointment with this surgeon, but I feel slightly awkward because I was unaware of AMA restrictions on socializing with patients plus I made the first move (I am a little shy when it comes to making first moves.) What do you think: was there attraction?


Answer by , MD: Some questions on my medical school exams had considerably more than the usual four or five choices, which enabled professors to craft questions with byzantine combinations, such as “b, d, f, g, and m are true,” “d, f, k, m, and o are true,” “three of the above are true” followed by “four of the above are true”—not so easy to answer when a question may have over a dozen options.

Those are tough questions. The question about whether your surgeon is attracted to you is considerably easier to figure out: yes, he is. In fact, I'd say that he is very attracted to you. To put it colloquially, he has the hots for you.

What red-blooded single man wouldn't? From the messages we've exchanged over the past few days and from the pictures you sent, it is clear that you have brains, beauty, and a good heart. You are kind, thoughtful, and considerate. In short, you have what almost every man wants, and what every every intelligent man wants. You're a great catch.

I wouldn't lose sleep over “AMA restrictions on socializing with patients.” First, they are just guidelines, not rules or regulations. The AMA has no power over doctors. The AMA once was a worthy organization, but it morphed into a self-serving sellout less concerned with doctors than with padding its own pockets. Most doctors I know loathe the AMA and speak of it with as much affection as they do the bubonic plague. Based on their frequent solicitations to join them, they are desperate for new members; the last one said, “Join the AMA for half the dues, receive $50 e-gift card for HP® products!” It was also emblazoned with “IMPORTANT TIME-SENSITIVE.”

American Medical Association letter

After opening it—something I rarely do for the pile of AMA junk mail I receive yearly—I found that I would also “receive up to [a] 30% discount on HP computing products—workstations, notebooks, tablets, servers, storage, networking, and printers AND free U.S. ground shipping.”

If the AMA were as great as it once was and could be, they would not need to stoop to such come-ons.

State medical boards regulate physician conduct, but as I mentioned in another posting, 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. I would not be surprised if a medical board, and individual members of it, were personally sued by a doctor if that medical board violated his constitutional right to privacy. The ruling might not only enjoin them from meddling in the doctor's private life, but impose a multimillion-dollar fine to penalize the medical board and its members.

No court or anyone with common sense would penalize a medical board or its members for castigating truly unprofessional conduct, such as one of my co-workers who would reportedly (according to my boss) get an erection and “press himself” against the vulva of patients during pelvic exams, evidently trying to impress them with the large size of his penis—or the small size of his brain.

Other clearly unprofessional conduct involves coercion, such as a doctor threatening not to help a beautiful patient, for example, unless she slept with him. However, there obviously was none of that in your case. You had a problem, the surgeon fixed it, you're human, he's human, and you are both adults free to say “yes” or “no”: the essence of the aforementioned sexual autonomy. Moreover, you both live in the United States of America, where people are constitutionally free to do as they please as long as they do not harm others.

Except for isolated cases, almost every doctor I know truly cares about helping patients to the best of their ability, often even when patients can't pay on time or pay, period. I've helped many poor patients for free, and it was indeed an honor to serve them, even when they weren't beautiful or even women.

I still recall with fondness one patient because he was poor, perpetually drunk, and foul-mouthed: not exactly the kind of person near the top of the “favorite patients list” for ER doctors. So what did I like about him? He had a life-threatening problem; another ER doc missed it, I found it, and saved his life. When I saw him in the ER weeks later for an unrelated problem, he was as irascibly profane as ever toward the nurses, but by reminding him how I saved his life, he turned into a pussycat and behaved like a gentleman from then on. It was an honor to be given a chance to make a positive difference in his life.

If a physician colleague of mine revealed that he would coerce a female patient, that doc would have more to worry about than the state medical board; I wouldn't tolerate such behavior. If he wouldn't immediately back down, I would initiate a series of events that would make the wayward MD wish he'd limited himself to controlling a blow-up doll.

The most beautiful patient I ever had gave me an offer that many men would not refuse: cash AND the chance to sleep with her repeatedly. Just one catch: she wanted me to write prescriptions for a powerful narcotic. Deciding what I'd do took only a millisecond: no.

Hell no, in fact. I didn't go to medical school to become a drug pusher or sellout to my principles (unlike the AMA); I went to help people, as your surgeon helped you. An integral part of the sense of right and wrong etched into my brain does not legitimize a relaxation of ethical standards when the briber offers to give me lots of cash and a great time in the bedroom with a woman who made most models seem like Plain Janes.

If I can turn down an offer like that, I am ethical enough to object to physician impropriety, and I see nothing wrong with the surgeon pursuing a relationship with you.

Doctors don't learn by osmosis

One more thing: If state medical boards are truly interested in having doctors adhere to certain guidelines (instead of just penalizing violations of them), they should do a better job of informing doctors of them by, for example, linking to them with every application and license renewal form. Most doctors likely never think of dating patients until some situation arises unexpectedly. In such cases, the doc may not have time to locate and read those guidelines, in addition to court cases related to them, such as lawsuits against medical boards for violating the right to privacy. As is true for so many things in life, there are clear-cut cases of permissible, definitely impermissible, and lots of gray-zone “maybe” situations.

Before I knew anything about this topic, I simply assumed that dating any patient was verboten, so I went back to playing with my transistors instead of women who expressed an interest in dating me. My idea of going out and having a good time meant going to Radio Shack or stores that sold even more esoteric electronics parts. That made for a safe if often lonely existence.

Sooner or later, every doctor who isn't an ugly jerk is bound to receive romantic offers from patients. Considering this virtual inevitability, every medical school should spend at least an hour covering it. Doctors don't learn by osmosis; we learn by listening to professors transmit their lessons, many of which are never found in the pages of textbooks. Almost universally, doctors sincerely want to do the right thing, which often means following rules even when we don't personally agree with them.

People in power are trying to fetter our freedoms by saying that “everything is impermissible unless I say it is,” but courts and various organizations (such as the ACLU) are resisting this tyranny. Therefore, it isn't uncommon to find rules, regulations, and even laws that are unlawful because they are unconstitutional. The United States Constitution has yet to be repealed, and it is the supreme law of the land, superceding laws, regulations, and ordinances that violate it. This means that everyone, including doctors, possesses freedoms they don't expect. Bureaucrats often overstep their authority because their arrogance often exceeds their knowledge of the Constitution, but the Constitution still reigns supreme.

Power-hungry control freaks

The world is awash with people obsessed with power. From the TSA worker who beat on her chest as she bellowed, “I have power! I have power! I have power!” to monarchs who don't give a hoot about the bloody roots of royal power, too many people are too eager to assert power they have no right to wield. The worst state medical board in this regard is the one in the state of Washington, which makes Nazi Germany seem downright permissive, based on what I've heard about how they trample the Constitution in their eagerness to impose unrealistic standards on doctors. As long as you don't live there, you and the surgeon are probably free to pursue a relationship once you are no longer under his care.

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