Sexual contact in the doctor-patient relationship in The Netherlands.

OBJECTIVE--To obtain data on sexual contact between doctors and their patients. DESIGN--Anonymous questionnaire with 17 items sent to all working gynaecologists (n = 595) and all ear, nose, and throat specialists (n = 380) in the Netherlands. RESULTS--Response rate was 74%; a total 64 doctors gave a reason for not completing the questionnaire. 201 (59%) male gynaecologists and 128 (56%) male ear nose, and throat specialists indicated that sexual feelings are acceptable in the doctor-patient relationship; 286 (85%) and 186 (81%), respectively, had felt sexually attracted to a patient at some time, as had 14 (27%) female gynaecologists. More than half (59%) of the doctors who indicated that sexual feelings are unacceptable in the doctor-patient relationship had experienced these feelings, and 91% of this group had a negative attitude towards these feelings. 4% of respondents in each group had had actual sexual contact with patients. Most gynaecologists were in favour of having more attention paid to sexual problems during training; having their professional society take an official viewpoint; subsequent public support of this viewpoint; and taking on an impartial counsellor for the patients as well as the doctors. CONCLUSION--Sexuality exists in the doctor-patient relationship. Gynaecologists have a higher risk of having sexual contact with their patients than do ear, nose, and throat specialists but compensate for this greater risk by a higher state of recognition and acknowledgement.     

Medical professionalism and the doctor-patient relationship

The practice of medicine increasingly poses obstacles to the cultivation of strong relationships between physicians and their patients. The current discussion of medical professionalism aims to identify some of these obstacles and to improve both the doctor-patient relationship and the quality of medical care. In this essay, we explore professionalism within the context of the relationship between physician and patient and examine the concrete actions, behaviors, and qualities that medical professionalism requires of physicians in today's challenging environment.     

Doing what the patient orders: maintaining integrity in the doctor-patient relationship

No profession has undergone as much scrutiny in the past several decades as that of medicine. Indeed, one might well argue that no profession has ever undergone so much change in so short a time. An essential part of this change has been the growing insistence that competent, adult patients have the right to decide about the course of their own medical treatment. However, the familiar and widely accepted principle of patient self-determination entails a corollary that has received little attention in the growing literature on the ethics of physician-patient relations: if patients are to direct the course of their own medical treatment, then physicians are at least sometimes to be guided in their actions on behalf of patients by values that are not, and may even be incompatible with, their own values. Unless it is supposed that it would be best if physicians were simply to accommodate any and all patient requests, a possibility I consider and reject in this paper, there are bound to be numerous instances of legitimate moral conflict between the preferences of physicians and patients. In this paper, I examine the implications of this sort of moral conflict from the standpoint of the integrity of the physician....I have also considered the common practice of patient referral from the standpoint of physician integrity, and asked whether a physician who refuses to treat a patient as a matter of conscience can consistently refer the patient to another physician for the same treatment....     

Images in cardiovascular medicine: Transkei heart

A 16-year-old student from the rural Eastern Cape (former Transkei) was referred to Capetown for cardiovascular evaluation because of a four-month history of progressive dyspnoea and cardiomegaly reported on the chest-X ray. At physical assessment he appeared chronically ill, the blood pressure was 110/ 70 mmHg, the resting pulse rate 114 beats/minute, regular and equal, with pulsus paradoxus of 14 mmHg, and the central venous pressure was raised with a positive Kussmaul’s sign. His lungs were clear, the heart sounds muffled, without a pericardial rub or knock, and the liver was palpable 2 cm below the costal margin.     

The doctor and the "delta factor": Walker Percy and the dilemma of modern medicine

As medical science progresses, a tension has developed between the art of medicine, which deals with patients as individual persons, and the science itself, which focuses on the objective pathology.This tension is furthered as medicine identifies itself increasingly with science. To explore the consequences of this unbalanced identification, and the strain it places on the physician-patient relationship, this article examines the thought of Walker Percy, and in particular his novel The Second Coming. In this novel, Percy, a physician by training, presents a case of a patient suffering at the hands of medicine-turned-reductionist. The novel highlights the breakdown of communication between physician and patient within modern medicine, and raises important questions about how to best understand, and thereby preserve, medicine's true art.