Ethical dilemmas: Affair to regret, date to forget
Editor's note: "The Higher Ground" is designed to keep ASPS members aware of the real-world ethical quandaries that plastic surgeons commonly face. The columnist, Joe Gryskiewicz, MD, Edina, Minn., has been practicing for more than 25 years, and he is a former member of the ASPS Judicial Council. Readers are encouraged to submit questions directly to Dr. Gryskiewicz at drjoe@tcplasticsurgery.com or to PSN at PSN@plasticsurgery.org. Names will be withheld, and the views expressed in this column are those of the author.
Q: I hate to admit it, but I had a long affair with a patient. It's a long story, but we got into an argument about whether she would benefit more from a brow lift versus an upper-lid blepharoplasty, and she ended up suing me for the surgical result - seemingly to have the "last word" in our relationship. Our affair was discovered in the course of the malpractice suit, and her attorney reported our liaison to the state medical board, which suspended my license for several months. I reported this to the ABPS, but do I have to report it to ASPS as well? I'm feeling pathetic enough and don't want to be further embarrassed.
A: Thank you for sharing your candid, painful story filled with harsh lessons and happenstance. It's not uncommon for members to report their plight to the Board while neglecting to inform the Society. The ABPS doesn't communicate with ASPS about such matters. Members must inform ASPS directly of any limitation of your license, or if convicted of a felony or other crime relating to, or arising from, the practice of medicine.
ASPS Code of Ethics Section 2, subsection I (A) discusses disciplinary action if a member's right to practice medicine is limited, suspended, terminated or otherwise affected in any state, province or country for violation of a medical practice act or other statute or governmental regulation - or if the member is disciplined by any medical licensing authority. The Ethics Committee will review your case. You may also have to meet with the Judicial Council to explain what happened. I can assure you that its members will be objective in their interview with you.
Q: I performed breast augmentation on a woman a year ago. I bumped into her at the gym yesterday, and we started talking. She's really nice - and she looks great! My divorce was finalized last month, and I'm interested in asking her out. It's been a year since her procedure; is that long enough to keep it from raising ethics concerns?
A: There's an old bluegrass song titled "There's More Pretty Girls Than One!" Dating per se isn't the problem, but another song title is perhaps more germane to potential problems: "Breaking Up is Hard To Do." If the relationship heads south, your previous doctor-patient relationship could paint a huge target on your back. Therefore, you need to ask yourself two questions before making this leap.
Question 1: Is it ethical for you to date former patient?
Question 2: Is it smart?
I think you can guess the answer to No. 2.
Regarding Question 1, technically you must discharge a patient before forming a first-time, one-to-one social relationship. How does her chart read? Does your last note state: "Patient discharged (from the practice)"? Or does it state: "RTO PRN?" The statement "RTO PRN" implies she's still your patient. This entry can be construed to mean your "doctor-patient" relationship still exists.
Next, each state has different guidelines regarding how much time should pass before a doctor-patient relationship is considered dissolved, but one year is a common benchmark. Regardless of your state's guidelines, dating a former patient could raise some eyebrows and may even prompt an anonymous complaint about you, submitted by someone only vaguely familiar with the details. In turn, this could provoke an investigation by your state medical board or the ASPS Ethics Committee.
Your divorce is frightfully fresh. Better to think twice, take a cold shower after your workout - and ask yourself if dating a former patient is worth it.
Q: A fellow plastic surgeon in my community is featuring a photo of a patient in an advertisement for special laser liposuction of the neck procedure. There is no indication however, that the patient also had a facelift and chin implant - which is pretty obvious in the photos. Is that OK?
A: This advertisement you describe sounds misleading. The ASPS Code of Ethics prohibits any ad that is a misrepresentation of fact, fails to state any material fact, or is likely to create false or unjustified expectations of favorable results. I would venture to say that a facelift and chin implant would qualify as material facts in this situation! The Code of Ethics further prohibits using images that falsely or deceptively portray the recovery from a condition and, as a result, creates unjustified expectations of favorable results.
I would hazard a guess that your colleague is probably highlighting the new laser he or she just purchased and is looking to drum up patients to offset its cost. This makes business sense, but it's not sensible. I would advise you to submit your summary - including a copy of the actual ad - to the Ethics Committee. Quote the ASPS Code of Ethics section to substantiate your case, which is Section 2, subsection I (G), numbers 1, 2 and 7.
If the Ethics Committee agrees with your contention that this ad is misleading, your colleague will be contacted by a member of the committee. If he or she immediately ceases and desists using this advertisement - or changes it to appropriately clarify the full procedure - the matter will likely be dropped. If the surgeon persists, the case will likely lead to an on-site meeting with the Judicial Council, where he or she can explain the merits of the ad in person.
Got an ethics question? Send it to drjoe@tcplasticsurgery.com or to PSN at PSN@plasticsurgery.org. Your question may be published in PSN, but names and other identifying information will be omitted.
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