It is an age-old story. Man meets woman; they fall in love
and plan to marry.
But in this case, there is a twist. A governing institution
steps in and says their feelings and plans are inappropriate.
The woman is reprimanded for misbehaving and sent to counseling
to see the errors of her ways.
No, this is not an Islamic story. And, no, its not
a church or religion that is intervening.
The woman is a physician and the man was her patient. And
the intervening group is the College of Physicians and Surgeons
of B.C. And the misconduct is "engaging in a personal
relationship with a patient." And, by the way, neither
of them complained or reported it to the College.
Remember when family doctors were friends, or the local doctor
went to the same church or was on the same bowling team? One
knew ones doctor and trusted him because he knew you
But no longer is this permissible. Physicians must keep themselves
apart, as a class of their own; avoiding what the Colleges
call "dual relationships."
What underlies this intolerance of the human experience is
the theory of a "power imbalance" between doctor
and patient. Supposedly the therapeutic relationship is so
imbalanced that physicians have all the power and can make
patients do and say whatever they want, while patients lack
the ability to make judgments or express agreement.
In arguing their case, the Colleges rely on the old Freudian
notion of "transference" which held that people
transfer on to people the attitudes, feelings and reactions
that they had in their relationships with early people, such
as parents or siblings. So they may react to a doctor, or
a teacher, the way they did with their father, both in positive
and negative ways.
In a simplistic way, Colleges take this theory and conclude
that patients unknowingly come to view their doctors as father
figures (or mother figures) and then, somehow, starting acting
as children and stop thinking for themselves.
Stretching this concept even further, some experts
would have our doctor not just sent to counseling, but to
prison. One psychiatric consultant to the Ontario College
described her activities as a "struggle to help (the
courts) understand that even if (he) was very seductive, that
was part of (his) transference or longing."
Accordingly, people surrender their ability to consent when
they become a doctors patient. In our love story, the
man lost his rights and became a child.
But dont most relationships, at least professional
relationships, have a power imbalance? Certainly my banker
or my lawyer has power, as well as access to my very private
information. And there have been times when I felt powerless
with my car mechanic and building contractor.
When the B.C. College was asked about these relationships,
their response was: "the doctor/patient relationship
is very different from that of client/banker or client lawyer.
The patient has to have confidence that the doctor will always
act with the patients best interests in mind."
What does that says about that Colleges view of banker
s and lawyers? Dont these professionals have their clients
best interest in mind?
And cant personal relationships contribute something
through both a personal knowledge of the patients and a greater
concern for their well-being?
Id rather have a doctor who knows and cares about me
than one who is remote and technical. Id rather that
they cared "too much" and tried too hard, than that
they relied on tables of probability to determine my treatment.
Now, in a small minority of cases, doctors drug or extort
their patients to secure sexual favours. These
are neither friendships or acceptable medicine. But in most
cases, complaints come out after the relationships have gone
sour. And in those situations, as in most instances when a
relationship end, someone is angry and wants revenge. In our
love story, the mans wife lodged the complaint, but
not against her husbands behaviour but against the doctor
for her supposed abuse of power.
All of this is possible because the Colleges want to appear
as if they are protecting the public. But are they?
In the broader perspective, the intolerance of these regulatory
bodies to the feelings and foibles of the human condition,
is changing medicine. Physicians, fearful of being misunderstood
or of being friendly, are becoming aloof; members of an "untouchable
caste." They are being told that they are a powerful
profession and must be cautious and benevolent with their
And all of this comes at a time when an American Medical
Association poll shows that people are losing faith in their
doctors, and are becoming distant and focused on money. More
than two thirds of those polled felt that their doctors did
not spend enough time with the people they care for.
Perhaps it is the Colleges and not the doctors who need the
counseling, to help them to re-discover their humanity and
to rejoin the human race.
Meanwhile, have pity for your doctor, caught in the no-win
situation of satisfying the Colleges and being human with
their patients; people who are their equals in most ways.