Help! I'm a resident and my patient is trying to seduce me!

Over the course of your medical training, you have become familiar with the age-old rule about how doctors should avoid pursuing relationships with their patients. (And ethical debates have dissected this topic extensively.^[])

Deflecting amorous advances from people you are treating is never easy, for any doctor, but these situations may be especially uncomfortable for residents, who are still learning the rules about effective patient communication.

First and foremost, talk to your supervisor

According to a study published in the International Journal of Women's Dermatology, a significant 83% of healthcare providers have reported instances of sexual harassment from patients.^[] It's important to discuss each incident to your supervisor, who should be able to advise you on next steps, such as requesting a transfer.

"Leaders can promote a culture of diversity, inclusion, and respect into institutional policies," the authors write. "Having a policy that clearly and visibly (eg, with signs posted in clinic spaces) states that harmful behavior such as SH/SA will not be tolerated by anyone, including patients, is an important first step in establishing behavioral expectations."

Residents can maintain open communication with their attendings and supervisors while meticulously documenting each incident to create a safer workplace for themselves—and to avoid any potential legal ramifications down the road.

Recognizing red flags

Let's be honest: We aren't necessarily prepared for deflecting romantic advances from patients. It's not something they teach us in medical school, right?

You might notice conversations with the patient veering toward nonmedical topics, or frequent compliments on your physical appearance, or even some overt, flirtatious behavior. The patient might try to initiate unnecessary physical contact or closeness, or go above and beyond with their gifts.

These days, patients with amorous intent may go to great lengths to pursue their romantic interests via text messages, emails, and contact on social media. The Medical Defence Union reports a rise in doctors seeking help because of “lovestruck” patients.^[] 

A notable case recounted in Medscape tells the story of a predatory patient who became infatuated with her gynecologist after falsely accusing him of inappropriate behavior during a medical examination.^[] Her obsession lasted 3 years and resulted in a trial, until she eventually confessed to fabricating the entire incident.

Motivations behind seductive behavior

According to a report published in American Family Physician, there is a high prevalence of abuse—including rape, incest, and physical violence—in the lives of such patients.^[]

Board-certified psychiatrist Sangeeta Hatila, MD, MBBS, defined the patient profile further in an interview with MDLinx. 

“They enjoy the excitement and drama of intense relationships, and seducing their doctor adds that thrill. It's also a way to manipulate the doctor into providing extra care or leniency,” Dr. Hatila continued.

But not all cases of seduction are driven by psychiatric disorders. Sometimes, say the Medscape contributors, it might simply be a misinterpretation of the doctor’s empathetic gestures and attentive listening, which results in erotic transference—an intense, irrational erotic preoccupation with someone giving care, characterized by demands for love and sexual fulfillment.^[] These advances symbolize an attempt to counterbalance the perceived dominance of the physician in the therapeutic alliance, according to the Medscape contributors.

Dr. Scott Cunningham offered a compelling example in an email to MDLinx, noting an encounter with a “seductive” Navy enlistee. This woman, devoid of familial support, was undergoing a cesarean section. Dr. Cunningham recalls that “shortly after the procedure began, she broke loose of the velcro and began feeling my rear end and saying, ‘I love the Commander’ with slurred speech” under “the disinhibitory effect of ketamine.”

Maintain boundaries and clear communication

So, how do you handle a seductive patient? 

Every time you have to touch a patient, state your purpose loud and clear. For instance, give them the lowdown during an abdominal examination: "I'm going to palpate your abdomen to check for any issues in your spleen and liver." And if you're on hernia duty, put it plainly: "Now, I'll be palpating you to check for any signs of a hernia."

Cut to the chase

Steer clear of ambiguous language that might unintentionally lead them on. 

But if things get out of hand, step up and confront the patient head-on. Articulate that their advances are impeding your professional responsibilities. Let them know that if the behavior continues, you will transfer their case to another doctor and no longer be their primary physician.

Avoid being alone with the patient

Request the presence of a family member or colleague of the same sex as the patient, during any physician examination. Consider leaving the door slightly ajar during non-invasive procedures to maintain a sense of openness.

Don't forget, if the situation escalates or becomes intolerable, request a colleague to exchange cases with you. 

Take immediate action

As noted above, make sure to bring up each incident to your supervisor. In the patient's medical records, document the incident and your efforts to maintain professionalism. The Medical Defense Union recommends keeping meticulous records of conversations, correspondence, and any exchanged gifts in such instances. 

Dr. Hatila says, “if you suspect there are deeper emotional struggles or psychiatric illnesses at play, consider referring the patient to a psychiatrist or therapist who can provide the support they need.”