Romantic Relationships with Patients: Your Obligation as the Employer

Is it ever okay to date patients? The unqualified answer is simply no.

The ethical considerations of personal relationships with patients are addressed in the ADA Principles of Ethics and Code of Professional Conduct. Under the Principle of Nonmaleficence (“do no harm”), the ADA states, “Dentists should avoid interpersonal relationships that could impair their professional judgment or risk the possibility of exploiting the confidence placed in them by a patient.”

When it comes to matters of the heart, however, objectivity can be compromised. Romantic chemistry happens, and there are risks beyond the ethics that can have profound impacts on your practice, whether or not the relationship works out. If an attraction develops, emotions and stakes are heightened. Consider beforehand how personal relationships could evolve (or devolve) into troublesome situations in the future. If you or any member of your dental team intends to pursue a personal relationship with a patient, the patient must be referred to another practice for care before the relationship begins.

The Dentist Insurance Company provides a no-cost Risk Management Advice Line to help CDA members and TDIC policyholders navigate challenging situations. As calls to the Advice Line illustrate, romances that evolve in business and health care settings often have an imbalance-of-power aspect that creates even more tension and risk — even when the relationship is between a staff member and a patient.

A case study in dating a patient

In a recent Advice Line call, a dentist shared how the complications of a romantic relationship between a staff member and patient were fueling drama and discontent in his practice. The office’s receptionist, who was married, had been dating an elderly patient who was professionally successful. The patient sent gifts to her and took her on lavish dates. The receptionist shared the details of her dating life with other staff members and admitted that flowers sent to her at the practice were from the patient.

The receptionist’s husband discovered the relationship and had “lost control” — getting into an argument with her in the office parking lot, which escalated into him throwing an item at his wife. The police had to be called to put an end to this disruptive and embarrassing scene.

In this case, the dentist did not wish to dismiss the patient due to the patient’s high standing in the community. To complicate the issue, while the dentist’s employee manual did include a policy that specifically referenced not dating patients, not everyone on his staff had provided a signed acknowledgment that they had received the manual.

The analyst urged the dentist to meet with the employee and remind her of the office policy and clearly communicate their expectation that she adhere to these guidelines. In addition, given the disruption that occurred when the patient’s husband confronted his wife at the practice, the dentist may consider obtaining a restraining order against the husband to prevent further occurrences. While employee termination may also be an option, the dentist was advised to consult an employment attorney prior to taking any definitive action.

Regardless whether the potential relationship with a patient is to be with the dentist or a staff member, the patient must seek dental care from another office. This can prevent potential financial and privacy concerns. What if the patient’s balance was forgiven or an unauthorized credit was placed on their account? If the relationship doesn’t work out, the patient could voice concerns about unauthorized access to private health information.

Patients should be able to trust their health care providers and have the expectation that any confidential information revealed will be used only in their best interest. This dynamic must not be exploited, regardless of the relationship status. If a romance ends, hurt feelings can even lead to retaliatory action taken by a patient, such as a complaint to the dental board or filing a malpractice claim.

What can you do?

• Lead by example.

As practice owners and employers, dentists must model the behavior they want to see in others. They should neither initiate relationships with patients nor encourage romantic interest. If staff members observe a practice leader setting clear boundaries with a patient and referring a patient to another dental practice when needed, they are more likely to make prudent decisions about their own behavior.

• Proceed with caution.

If you have weighed the potential consequences of dating a patient and are serious about pursuing a relationship, you must refer the patient to another provider. Include staff in your reasoning about these types of decisions, as it will demonstrate accountability and encourage discussions around similar situations among the team.

• Put your policy in writing.

The Dentists Insurance Company recommends a written office policy that is applied universally, regardless of the staff role. In addition to having a policy in place, you should also communicate what behavior is unacceptable in the workplace, such as certain displays of affection and discussing relationship issues. For any employment policy, the consequences of violation should be equitable and clear. It can be helpful to establish an anonymous reporting process to allow employees to feel more comfortable to share when they’ve witnessed violations or concerning situations.

• Add a layer of protection.

If you haven’t already done so, consider adding employment practices liability (EPLI) coverage as an endorsement to your professional liability policy. EPLI can provide protection if you or one of your employees is sued for harassment, discrimination, wrongful termination, failure to promote or other employment-related issues. Talk to your trusted insurance advisor about the right coverage for your practice’s needs.

In any workplace, navigating relationships is complicated. But the potential for unforeseen and possibly high-risk issues increases when a dentist — or anyone else on the practice team — chooses to date a patient. Protect yourself, your staff and your practice by keeping relationships professional.
 

TDIC’s Risk Management Advice Line is a benefit to TDIC policyholders. To schedule a consultation with an experienced risk management analyst, visit tdicinsurance.com/RMconsult or call 800.733.0633. For Risk Management guidance in Idaho, Oregon or Washington, call 800.452.0504.