I read with considerable dismay Dr. Avitzur's October 4th article in Neurology Today regarding sexual misconduct. While I agree that the issue is important and I agree with his "red flags" and concern about prevention, I think he skirts the primary issue. When Hippocrates first wrote his code, I doubt that he was thinking about repercussions from his attorney friends on the Acropolis. Sexual misconduct is misconduct for the damage it does to the doctor-patient relationship, and most importantly, the patient.
I recently discovered that my wife had been having an ongoing sexual relationship with her neurologist. She had been referred to this neurologist by another physician because of neuromuscular pain which did not respond to medication. An MRI revealed white-matter lesions which had not been present in an MRI taken five years prior. He ordered an electromyography which returned negative, ruling out MS. In the course of these visits she had revealed other aspects of her clinical history and emotional state. At this point, without a conclusive diagnosis for the pain or the MRI, the neurologist began "palliative" care, consisting of Coenzyme Q10, a few sleeping pills, and lots of wine and personal attention.
All of the red flags were present from the beginning. Prior to their first meeting outside of the office, he had already "prescribed" books on spiritualism and started discussing his personal life. After one of their first lunches, he had arranged a hotel room for the afternoon, and what happened happened. My wife told me that she was seeing her neurologist outside of the office, even mentioning the hotel room, but claimed that the relationship was platonic. Trusting my wife and the neurologist's oath, I actually encouraged the friendship, as it seemed to improve my wife's spirits and lift her pain. They continued to see each other frequently in his office after hours or in hotel rooms once or two afternoons per week.
Over the next year, my wife started developing other neurological and neuromuscular symptoms which I found troubling. I asked her if she was discussing these problems with her "neurologist friend", but she said that she was uncomfortable discussing her condition with him. While sexual intimacy should be an expression of openness and honesty, in this case it was interfering with the open flow of information between doctor and patient. While this neurologist is still technically her doctor, she is getting no care. As her spouse, I am excluded from discussing her condition with her physician or participating in her care. When a patient ceases to discuss her condition with her physician for fear of being less attractive or desirable, medicine is compromised. This is particularly the case with neurology, which touches the way that we think and feel.
When I discovered the true nature of the relationship last summer, I was upset for all of the normal reasons. It disturbed me greatly that the doctor's breach of practice had put his interests ahead of those of his patient. I find it particularly distressing to think that this neurologist may have used clinical information (history or worse yet MRI findings) to exploit my wife’s vulnerabilities. My wife has ended the sexual, physical aspect of their relationship, but wishes to remain a friend, albeit one they she can no longer trust fully. She understands now that she needs another neurologist, but is dragging her feet for fear of disrupting this friendship. She doesn't want to report the doctor to the state board for the same reason.
I hope that my wife's experience is the isolated exception, but given the dynamics, unreported sexual misconduct may be more prevalent than we would wish. In this particular case, standard audit precautions would have discovered the relationship. This doctor exchanged over 500 email messages with my wife using his hospital email account, .@.org. His colleagues had noted his change in appearance and demeanor without asking how he met his new "friend".
My reason for writing this letter is a hope that the medical community can do a better job of monitoring its members and safeguarding its patients. Certain email practices should be considered NSFW (not suitable for work), and could easily be tracked without violating doctor/patient confidentiality.
1. Frequent emails between the professional account and a personal account, as identified by the common personal account domains (hotmail, gmail, yahoo, etc.).
2. Emails that include certain words (sex, love, etc.) repeatedly.
Perhaps audits of this nature would simply move the correspondence elsewhere, but patients could be warned that any email contact outside of the official channels is an implicit breach of professional conduct. If an industry-wide audit reveals that half of the U.S. News and World Report top ten Neurology and Neurosurgery programs have problems, then the problem is at least five times as great as this particular case.
Again, I hope that I am preaching to the choir. I continue to consider Neurology a sacred science that treats conditions at the core of how we define humanity. I applaud the fine work you all do to improve the lives of countless people.