Where Is The Line? Evaluating The Integrity Of The Patient-Doctor Relationship

As I sit here, all fired up, ready to share a story, I realize that I am not alone. What happened to me has, I’m sure, happened to so many of us. Because I realize this experience can happen no matter what gender identity the doctor, patient, nurse, or staff person is, I will use only “they” or “them” pronouns here.

Where is the line when it comes to a productive, healthy and safe patient-doctor interaction? When is enough, enough?  When is the patient-doctor relationship compromised?  When should one terminate this relationship?

Is it when the patient blows kisses at you? What about when they rub your shoulder or arm in the hallway before or after treatment? Perhaps, when they tell you their spouse is out of town, so you should make a house call and spend the night? Is it when they poke you in the stomach with their cane?  When they tell you, as you are losing weight, that you are getting too hot? What if they ask you for a massage (winking while they clarify that they don’t mean their feet)? Is it when a nurse asks them a question about a dressing, and they say they would prefer the nurse undresses? Or, when the patient asks if your spouse will share you with them? Maybe, it’s when you have multiple nurses who won’t be alone in the room with the patient because of their behavior? Or, when they tell you to lean over a little more?

What if everything described above were the actions of one patient?  When is/was the line crossed? For me, it was yesterday. The day prior to writing this blog was the day when they, seated in my elevated chair with their legs at eye level, slowly moved their cane off their lap and said, “I want you up here,” while patting their upper, inner thigh area.

I have a long history with this patient. At first, when their spouse was present, this behavior did not happen. As care progressed, the patient came alone and things began to worsen. They are, unfortunately, not the only patient who makes inappropriate comments. I think the caregiver part of me lets it roll off to some extent. I feel like I want to help as many people as I can. Depending on the situation and circumstances, I will verbalize if their behavior is inappropriate or uncomfortable. I don’t think that it is ever okay to make someone feel that way, but I also always want to provide care for my patients. In the case of this patient, I had been their doctor for three years and wanted to be the best provider I could.  I emphatically know that, during the entire course of care, I separated my feelings from the care and prioritized their well-being.

I told this patient that I would be unable to continue treating them if this behavior didn’t change.  And yesterday, it didn’t just continue; it finally crossed my line. I don’t know that I really knew where my line was until that moment. The moment they patted that area, I knew there was no going back for me. I completed my care, ensured that their feet were stable, and finally said something. My practice and I began the process of formally discharging this patient.

Today, I feel guilt, partly because I am stopping my role in their care, but also because of some reactions to my decision. I received feedback from more than one person who felt that this behavior did not warrant my reaction. One person felt my actions were acceptable only after learning that I had discussed their behavior with the patient multiple times. Another thought that writing down the warning was enough. Last night, when I shared with my friend what had happened, I said I was feeling guilty. My friend reminded me, “You deserve to be treated like a human being, not an object.”  My friend is right. My nurses, staff, and all health care providers deserve that, as well.  That is how I am working through my feelings. NO ONE deserves to feel that way. I did my absolute best to care for this patient, but I can do so no longer. And that needs to be okay.    

Dr. Hook is a Trustee of the New York State Podiatric Medical Association, Chair of the NYSPMA Public Education and Information Committee, and a sub-Chair of the American Board of Podiatric Medicine Membership Committee in the Crisis Communication and Audit division. She is Secretary for the American Association for Women Podiatrists and is in private practice at Syracuse Orthopedic Specialists in Syracuse, N.Y.