Can chiropractors dating former patients
Except when a patient is raped, the therapist who eventually sexually abuses a patient follows a remarkably predictable ‘natural history' of sexual misconduct.” Not all stages will take place in any one relationship, but the general stages include: gradual erosion of therapist neutrality; socialization of therapy; the patient is treated as ‘special'; doctor's self-disclosures begin; physical contact begins (e.g.
hugs, kissing); extratherapeutic contacts occur; dating begins; sexual intercourse occurs.
To explain why this is always the case, even with former patients, it is useful to consider the sources of medical power in light of a framework suggested by family practitioner and ethicist, Howard Brody. Simply by the sheer nature of taking on the role of patient, regardless of any other type of power, there is an unequal power differential between the doctor and patient.
Nor do all boundary transgressions between doctor and patient ultimately lead to sexual misconduct. A key factor in the identification of doctors at risk of violating boundaries is the enhanced vulnerability of a doctor to the transference–counter-transference dyad which occurs in varying degrees in every doctor–patient relationship.
Transference is “the unconscious assignment to others of feelings and attitudes that were originally associated with important figures” by the patient onto the doctor.
This has been documented extensively in the literature, with no counteracting reports of successful relationships and non-abusive consequences being published.
This does not mean that no such type of relationship may exist, but it has not been researched.In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor–patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient.