lecture 4: sexual misconduct and boundary violations in medical practice

fiduciary relationship

the doctor patient relationship is a _______ relationship that has at its center the element of trust

fiduciary relationship

•a special relation of trust,

confidence or responsibility in one's obligations to others

•The doctor-patient relationship is not an equal one no matter how egalitarian the physician may wish to be.

•Patients come to physicians for their expertise, and they come in a highly vulnerable and often regressed state.

is the doctor-patient relationship equal?

-case by case basis

-never in psychiatric cases

is it okay to have sexual relations with a former pt

•This behavior is non-diagnostic and non-therapeutic, may be verbal or physical, and may include expressions of thoughts and feelings or gestures

that are sexual or that reasonably may be construed by a patient as sexual.

define physician sexual misconduct

sexual violation and sexual impropriety

what are the two levels of sexual misconduct?

Sexual impropriety

Performing intimate examinations with no explanation, using the physician-patient relationship to solicit a date, discussing personal sexual experiences, preferences, or fantasies

no

is patient consent a legal defense in a sexual misconduct case?

-sexual relational content

-intoxication or substance use

-threats to pt confidentialiity

-affiliation with schools

list some online boundary violations

minor illnesses, temporary or emergency situations.

treatment of immediate family members should be reserved for

•State laws require the presence of a valid physician/patient relationship before any controlled substance can be prescribed.

prescribing controlled substances requires

multiple or dual relationships

•Such relationships can occur anytime that a physician relates to patients in more than one relationship, whether professional, social, or business in addition to being in the treatment relationship.

multiple or dual relationships

these relationships •can lead to

allegations of taking unfair advantage

of the treatment relationship

to exploit or otherwise further the physician's

personal, religious, political or business interests.

serve the immediate and pressing needs of their pts

In general, physicians should limit sales to products that

giving sufficient, advance notice to the patient

in order to ensure continuity of care and

to permit another medical attendant to be secured

-should be given ample notification

in writing, sent by certified mail, to the patient's or his or her legal representative's last known address

how must a doctor terminate physician patient relationship?