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You, who are medical directors out there, please consider how you would react to a request for an out-of-network referral based on "personal reasons." The geographic reality doesn't create the ethical bind, but a contractual restriction.
I'd counsel any MCO or physician group facing this issue to step out of the way instantly.
Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship." Note that this last statement leaves open the possibility that such relations might not be unethical if the physician doesn't exploit aspects of the former relationship.
Also, the AMA is silent here about former lovers becoming current patients. Colorado's Medical Practice Act specifies a six-month "waiting period" after a professional relationship has ceased before a sexual one may begin.
One could argue that married couples are an exception,but that view requires an understanding of relationships that is absent from the "no overlap" policy.
When we worked in a rural town, and even after moving to the city, we occasionally examined, evaluated and treated each other for medical aliments and injuries.
Our contemporary attitude toward such encounters is to label them, categorically, as "unprofessional conduct." Given that there is no surveillance of this behavior, physician-patient sex comes to the attention of regulatory agencies only when the patient complains. The nominal standard establishes a rule of "no overlap": a physician-patient relationship must not coexist with a romantic-sexual relationship.
The AMA says: "Sexual contact that occurs concurrent with the physician-patient relationship constitutes sexual misconduct.
For psychiatrists, it is a violation to cross the "patient-lover boundary" with any person who has ever been in the other role.
According to the American Psychiatric Association: "Sexual activity with a current or former patient is unethical....