Sometimes the risks to our professional standing outweigh the need for patient care, writes Dr Leon Piterman
Doctors in general, and GPs in particular, form close professional relationships with patients and their families. We share in their joys and we are affected by their sorrows.
However, at all times those relationships need to remain professional, and in instances where boundaries are inappropriately crossed doctors run the risk of suspension from practice, deregistration and, in some cases, may face criminal charges.
Our training prepares us to define those boundaries and to act ethically to avoid circumstances where clinical care is misconstrued for loving, personal care.
Patients and their carers may find themselves vulnerable during times of crisis and may misconstrue the attention that we, as GPs, give in difficult circumstances.
The case of Jane, below, illustrates the difficulties that arise when patients themselves cross boundaries.
Jane was aged 30 and was living with, and caring, for her 65-year-old mother, Louise, who had terminal breast cancer. She was married to Chris, a 35-year-old mining engineer who was often travelling interstate or overseas. They had a three-year-old daughter, Stephanie, who attended a local crèche.
Jane’s parents divorced many years ago and her father had remarried and was living with his family in New Zealand. Jane had no siblings, so was the sole carer, and found herself part of the “sandwich generation” looking after a critically ill mother and a young child.
Louise had been a patient of our clinic for 20 years. The breast cancer was diagnosed eight years earlier and, although apparently eradicated, returned with bone and lung metastases which had not responded to treatment, and she was now in palliative care.
As part of the palliative care team I visited Louise on a weekly basis, prescribed her medications, listened to the difficulties she and Jane were encountering, and offered support and advice. Home visits were made simple as Louise and Jane lived only a few hundred metres from the clinic and were often accompanied by a welcome cup of coffee. Having cared for Louise for such a long time I felt it reasonable to supply my home number in case of emergencies. I was sure this would not be abused.
My car was often parked in an allocated “Doctors Only” space close to the clinic. On a number of occasions, in fact almost every second day, I noted a flower placed under the windscreen wiper of my car.
At first I didn’t think much of this, but given its regularity, I felt I must have a secret admirer. I mentioned this to my colleagues who laughed it off.
Then the phone calls came. At first they were directed to the clinic and would generally happen around midday. The female voice told the receptionist: “Please let Leon know that we will meet for lunch at the usual place … he will know where it is.” No identification was offered.
With a wry and suspicious smile, the receptionist informed me about my regular lunch-time date. I found it hard to convince her of my ignorance, or my innocence. These lunch-time dates turned into dinner dates. And then I began to receive calls at home, accompanied by heavy breathing.
When my wife answered the phone the heavy breathing was absent. The calls were so frequent that eventually I had to arrange for Telstra to put diversion mechanisms in place.
Having cared for Louise for such a long time I felt it reasonable to supply my home number in case of emergencies.
I notified the local police who informed me that no crime had been committed so there was little they could do. I notified my Medical Defence Organisation, which offered support and recorded my story.
During this time I continued to visit Louise. I became suspicious when I noticed Jane went to some lengths with make-up and stylish clothing for my visits, but it was not until one of our receptionists caught her red-handed placing a flower on my windscreen that the mystery was solved.
I felt insulted, violated and confused and needed advice and counselling.
I also felt that I could no longer care for Louise and was advised my Medical Defence to hand her care over to another doctor in the clinic.
I was concerned for Louise. She was clearly unaware of Jane’s activities and would be concerned that I had abandoned her. However, I had little choice.
A timely holiday break gave me an excuse to hand over her care. Confronting Jane was difficult and I chose to do this by phone. A week later I received a long letter of apology which outlined her confused feelings for me, as well as the difficulties she was experiencing in her marriage in addition to dealing with the imminent death of her mother. Understandably, she felt lost. However, I was not in a position to be her saviour.
There are times when the risks to our professional standing and our future outweigh the need for patient care. This was one of those occasions.
Louise died four weeks later.
Jane subsequently left her husband and moved to New Zealand. I later received a Christmas card from Jane informing me of her new-found love and thanking me for caring for her mother.
Professor Leon Piterman is Professor of General Practice at Monash University and has been in clinical practice for almost 40 years
Do you have similar professional experiences you’d like to share? Please email firstname.lastname@example.org