HEALTH practitioners need more specific advice from their Colleges and governing bodies to determine what defines a “former patient” and how to navigate a safe and appropriate conduct a non-therapeutic relationship, says an Australian expert.
Professor Jenni Millbank, Distinguished Professor of Law, and Director of the Law Health Justice Research Centre at the University of Technology Sydney, told InSight+ in an exclusive podcast, that there was a common misconception among health practitioners that a sexual relationship with a former patient was okay.
“If they find themselves attracted to a patient, if they don’t believe there’s a very serious power imbalance with the patient, and the patient doesn’t believe that either and they mutually affirm that with each other, [there is a fairly common misconception] that if the health practitioner says ‘let’s just stop me treating you and you won’t be my patient and it’ll be fine’,” said Professor Millbank.
“That’s really where a lot of practitioners can come unstuck.
“Some of these relationships are understood by the parties involved as genuine romances and they don’t see themselves or understand themselves to be behaving abusively. But at the same time, they’re not getting outside advice.
“They’re not stopping and putting in place a process whereby there’s any kind of check or balance, and they’re not making sure that the patient is getting health care from someone else.
“So, with all good intentions in some of the cases, that situation then snowballs into one of secrecy and deception and records being covered up or falsified. Then when it all goes wrong and comes out, it can be very harmful to the patient and the practitioner hasn’t themselves been able to access any good guidance or assistance.”
Psychologists, Professor Millbank said, lead the way in terms of guidance for practitioners in this area.
“Psychology has done two things. One is they have set a 2-year period [in which relationships with former patients are prohibited], but the other thing is they have set a process,” she said.
“They actively investigate – what does this mean for the patient? What does this mean for the professional? Each of them should have separate advice and that process should be a managed process, that involves open disclosure.
“It’s not just ‘time on the bench’.
“It would be more helpful I think, if practitioners were able to access advice and support and have those kind of processes clarified upfront, rather than, getting a sense from a legal decision after it’s all gone wrong a couple of years later.”
Professor Millbank said that it was female health practitioners who more often “had a blind spot in terms of their own position of power as a health practitioner”.
“They were much more likely than male health practitioners to characterise what was happening as a romance, as okay,” she said.
“Male practitioners are more likely to be involved in relationships with multiple patients or clandestine relationships with patients.
“Female practitioners are more likely to have an idealised romantic notion that this was fine, this is their true love. They are more likely to be open about it, but they were also more likely to not get it. That did involve them in many cases of using a position of power.”
Professor Millbank told InSight+ that medical education needed to involve specific advice on this subject.
“Every profession has a kind of, ‘don’t do this’ in their educational process,” she said.
“But it needs to be more developed and it needs to be more about what do you do if you find yourself in this position. How do you avoid getting yourself into this position and what do you do if you, for instance, believe yourself to be genuinely in love with a patient or a former patient or family member of a patient. There has to be a process, a process of support and supervision to assist that person to get out of that situation without causing damage.”
Professor Millbank is the author of a Perspective published by the MJA today.