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By Vicki L. Buba JD

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

By Dr. David Edward Marcinko MBA CMP™


An “Amorous Relationship” is defined as a consensual romantic, sexual or dating relationship. This definition excludes marital unions. The term also encompasses those relationships in which amorous or romantic feelings exist without physical intimacy and which, when acted upon by the faculty or staff member, exceed the reasonable boundaries of what a person of ordinary sensibilities would believe to be a collegial or professional relationship. The faculty/student and supervisor/employee relationship should not be jeopardized by question of favoritism or fairness in professional judgment.

Furthermore, whether the consent by a student or employee in such relationship is indeed voluntary is suspect due to the imbalance of power and authority between the parties. All members of the healthcare entity should be aware that initial consent to a romantic relationship does not preclude the potential for charges of conflict of interest, or for charges of sexual harassment arising from the conflict of interest, particularly when students and employees not involved in the relationship claim they have been disadvantaged by the relationship. A faculty, staff member or graduate assistant who enters into an “Amorous Relationship” with a student under his or her supervision, or a supervisor who enters into an “Amorous Relationship” with an employee under his or her supervision, must realize that if a charge of sexual harassment is subsequently lodged, it will be exceedingly difficult to prove blamelessness on grounds of mutual consent. This policy is superseded by the laws governing inability to consent based on age.


While physicians vary in their approaches to managing flirtatious patients, many agree that nipping the behavior in the bud is critical to maintaining professionalism and upholding ethical standards. “It’s flattering to have a flirtatious patient,” said Dr. William P. Scherer MS, Professor of Radiology at the Barry University School of Medicine, Boca Raton, Florida. “But, we have an obligation to protect the integrity of our medical profession, and to our marital contracts and spousal relationships and family, and to act professionally at all times” [personal communication].

Dr. Scherer finds it helpful to put some professional distance between himself and a flirtatious patient. “I have no problem saying to a patient: I appreciate what interests you may have, but I have to draw the line to take proper professional care of you, instead.”

And a good way to derails flirtatious behavior from patients is by deflecting their unwelcome comments. “And, you can’t act sheepish about it.” When a patient’s remark crosses the line from complimentary to something uncomfortable, the doctor may either curtly laugh it off or ignore it. “I don’t acknowledge the statement and immediately move the conversation into something clinical in order to put the rest of the visit in a serious tone.”

On the other hand, Dr. Barbara S. Schlefman MS, a fitness trainer and retired podiatrist, instructed her nurses to have another staffer accompany them into an examination room when a patient is known for being flirtatious was waiting to be seen; and to leave the door open [personal communication].

Likewise, other physicians use a “more is merrier” approach for themselves and their staff as a defense against flirtatious behavior. This is a problem that can be avoided by having physicians never see patients alone. So, as Dr. Schlefman advised, be sure to always a nurse or medical assistant in the room with the physician, even if you have to see somebody in the office on call after hours. And, be sure to have a call schedule for the nursing and medical assistant staff that includes patients of both genders, regardless of physician gender, since flirtatious behavior can be same-sex flirtatious behavior. Fortunately, adjunct or visiting clinical professors, or doctors on a medical school clinical teaching staff, rarely have patient encounters without a medical student, intern, resident fellow or nurse in the room during examinations.

Recognize the Signs

While it’s important that physicians don’t act on a flirtatious patient’s advances, it’s equally critical to recognize subtle flirtatious signs from a patient; according to Donna Petrozzello MD, an otolaryngologist at the California Sinus Centers.

A patient that maintains unusually long eye contact with their doctor, or engages in talk not related to their visit, or makes a habit of touching the physicians when not medically necessary may be flirting. Additionally, doctors can protect themselves when performing some common procedures that put the physician in close proximity to a patient’s face, breasts, genitals, legs and even feet. That closeness could turn a clinical exam into a flirtatious event. Wearing a mask to perform each of these local or regional examinations is not only for the purposes of infection control but gives the added benefit of establishing some personal space and protection, to avoid any potential misunderstanding. For example, auscultating lungs through a shirt, not underneath, is a good idea with this type of exam on a young woman patient.

[Two icons of romantic relationships]


Potential Outcomes of Flirtatious Behavior

Although flirting may seem innocent in most situations, it can have serious consequences if it persists and escalates between a physician and patient, particularly if the physician becomes sexually involved with that patient.

For starters, physicians who become romantically involved with patients may lose sight of their professional obligation to be objective in treating them. “When you’re biased in your decision making, or so emotionally attached to a patient that you can no longer be objective, then you’re no longer on your game, and you’re no longer able to provide the best quality of response that the patient deserves”, according to Render Davis MHA CHE, a medical ethicists formerly from Crawford Long Hospital, and Emory Healthcare, in Atlanta, GA [personal communication].
Additionally, a physician may be the target of a civil lawsuit by a patient when the relationship comes to an end. Using the defense that the relationship was consensual is typically not a strong one, given societal views that physicians are in the power position when it comes to initiating, or ending, a physician-patient relationship.

If a physician is found to have engaged in sexual misconduct with a patient, he or she may be sanctioned by a state medical board, which can dole out any number of punishments, not limited to censuring the physician privately or publicly or revoking his or her license to practice medicine, said Dr. Charles F. Fenton III, JD PC; a doctor and health care attorney, in Atlanta, GA.
Fenton advises physicians to tell patients, in no uncertain terms, that flirtatious behavior isn’t welcome. “It’s very clear that a physician cannot engage in flirtatious activity with a patient. If the activity continues on, the physician has no option but to terminate the relationship,” he said. “I would follow up a termination letter in writing and tell the patient: You may seek a physician of your choice, or, if you need a recommendation, we are happy to provide three names.”

How to Discourage Flirtatious Patients

• Bring a medical assistant into the exam room. A third person can squash a patient’s urge to flirt and also serve as a witness to the appropriateness of the physician-patient encounter.
• Don’t let a reassuring pat on the back, warm handshake or comforting hug become misconstrued. Doctors must be careful that patients don’t perceive their compassionate care to mean they are interested in pursuing a deeper relationship.
• Preserve the personal space between yourself and your patient. Wear a protective mask when performing sensitive clinical procedures and exams that require you to be close to a patient’s head.
• Keep the conversation polite but focused on a clinical topic. Don’t engage in flirtatious banter with patients or entertain their suggestive comments.
• Be sensitive to the fact that flirting can occur. Learn to recognize the subtle signs of flirting and quickly put an end to the behavior.


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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™


6 Responses

  1. Dr. Marcinko, and Ms. Buba,

    Perfect political timing for this excellent publication. It prompted me to purchase your textbook on risk management, as well. Many thanks.



  2. Dr. Marcinko,

    I agree with Janice; well done and timely, too!



  3. Agree,

    With all the comment above. Much appreciated.



  4. A Culture of Bias at Fidelity?

    The trouble for Erika Wesson at Fidelity Investments began with an anonymous email.




  5. Online harassment is super-slippery to define?

    A new Pew study hints at why social networks rarely get harassment issues right.

    A question: A argues digitally with B. A forwards it to C, who posts it online. B gets unkind and vulgar messages, and is doxxed and threatened. Was B harassed?

    The results: 89 percent of folks say yes. But there’s little consensus about when it occurred or when to intervene. Race and gender issues make it more divisive.

    Why it matters: To stamp out online harassment we need to agree on what it is, when it happens, and what to do about it. The results suggest that’s a distant hope.

    Dr. David Edward Marcinko MBA


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