Thursday, November 29, 2012

More about the Massachusetts Board of Registration in Medicine and Doctor-Patient Sex

There were two letters to the editor in today's Boston Globe about the Massachusetts Board of Registration in Medicine's decision to take away Dr. Gary Brockington's license. (See here for my original post.)

Nurse Mary Hourihan gives a perspective on Dr. Brockington's overall practice like what we've heard from patients of other physicians who have been disciplined for sexual relationships with patients:
As a nurse who has worked at the Faulkner Hospital for more than 30 years, I was shocked and saddened to read your article concerning the state Board of Registration in Medicine’s revocation of Dr. Gary Brockington’s medical license (“Board revokes Faulkner cardiologist’s license after affair,” Metro, Nov. 24). The doctor has cared for his many patients with the utmost professionalism and expertise. Although I do not work directly with him, nearly every day I hear from our mutual patients the reverence in which he is held.

The board is denying thousands of patients the skilled, sensitive care this extraordinary physician provides. I feel that Brockington and his patients deserve reconsideration of this decision.

Mary Hourihan

West Roxbury  
There's nothing surprising about the fact that a physician who displayed a serious ethical lapse with a patient may have been an excellent physician for most or almost all of his patients. (For example, see here.) In my own experience, a former colleague who I knew to be a superb physician, such that I referred one of my sons to him for allergy care, has been convicted for murdering his wife! In prison, he continues to evince the caretaking characteristics that were so prominent in his care of patients. (See here.)

Donald Ross, a physician colleague of Dr. Brockington, comes to the same conclusion I did - that if Brockington's relationship with the patient was a brief, one-time event that occurred during a period of major stress, the Board's actions were too harsh. But I don't agree with Ross that the Board's decision necessarily reflects "lack of compassion." A Board can impose a severe penalty and still regard to person being penalized with compassion, in accord with the precept that we should hate the sin but love the sinner.
In reading the story about Dr. Gary Brockington’s affair with a woman who was a patient and a co-worker, it strikes me that the reaction of the state Board of Registration in Medicine was over the top and lacked compassion in its response (“State revokes Faulkner cardiologist’s license after affair,” Metro, Nov. 24).

Perhaps there was poor judgment involved, but this does not sound like a case in which a doctor used his position in the doctor-patient relationship in an exploitative way. Brockington was also going through a difficult time in his own personal life at the time, and sometimes we don’t make our best decisions under such circumstances.

Perhaps it would have been more appropriate to require Brockington to enter a counseling program rather than imposing what is essentially a death penalty to his career.

Dr. Donald G. Ross

North Andover
As I said in my original post, if Brockington's relationship with his patient was (1) brief, (2) a single occurrence in his practice and not a pattern, (3) occurred at a time of major stress, and (4) has been followed by years of responsible caretaking, than (5) permanent loss of license seems too severe a penalty. This is not a matter of compassion but of realism. Some perpetrators of unethical behavior can be rehabilitated and will be able to serve others in a reliably ethical manner.

6 comments:

Anonymous said...

Dr. Jim Sabin,

This isn’t really the thread to ask this question, but since I came across your blog via a google search about relationships between doctors and patients, and this is the most recent article on the subject (I am finding reading about this and other ethics quite interesting), I would like to ask a personal question about relationships with doctors and former patients.

I have a crush on my physical therapist. He is kind, intelligent, respectful, and very professional. Nothing inappropriate has transpired over the few visits we have had. But I found myself very attracted to him on my most recent visit - after a couple years of not having seen him. He is very good looking, physically active, single, and my age (young thirties). I am not inclined to even flirt because 1) I am way too chicken and 2) it doesn’t seem ethically appropriate. However, part of me wants to entertain the idea of changing physical therapists and be upfront that I left because I was attracted to him, and see if as a former patient he might act on that knowledge. I am curious enough to google the subject, start reading articles about ethics, and even look up the physical therapy association guidelines. But the only thing I could find was a line that relationships between physical therapists and patients are not considered ethical. I am therefore wondering if you know what rules apply to physical therapists for relationships with former patients. I understand that mental health professionals, psychiatrists in particular, should never let a relationship develop with a former patient. But do you happen to know the rule for physical therapy in California? If it is allowed after a certain amount of time? Because if it is not ethically a possibility, I’d rather save myself the embarrassment – since I really don’t know if the attraction is reciprocated. Although I will probably change physical therapists anyhow for my own comfort.

--Contemplating-the-Conundrum

Jim Sabin said...

Dear Anonymous -

Thank you for this thoughtful question.

I went on line and read the code of ethics for both the American and Canadian Physical Therapy Associations. Neither directly addresses romantic relationships between a PT and a patient. There's no prohibition, as there is in the American Medical & American Psychiatric Association codes.

As I think of it, the professional code applies to the professional, not to the patient. I think of the patient as bound by "ordinary human ethics." In my view, this doesn't preclude expressing an interest in or attraction to the therapist. You sound like a thoughtful person, and if you think well of the PT as a person as well as feeling attracted to him, explaining the situation as you described and switching to another clinician seems quite reasonable. As a practical matter I'd advise against continuing as his patient and hoping he'd get interested in a personal relationship, as opposed to being direct about the situation with him.

Thank you for raising this question and sharing your thoughts!

Best

Jim

Anonymous said...

Thank you. I appreciate your response. I like how you state that I am only bound my ordinary human ethics. I plan on switching physical therapists and will see what happens. Although it definitely will take a lot of nerve to be direct ;-).

Anonymous said...

As a patient (I guess former, now) of Dr. Brockington, I am saddened by the harsh actions taken against him. He was truly the most caring, helpful, and trustworthy doctor I have met in my journey of many medical issues. From the facts as I know it, it was a brief 2 week affair, in which she was also an employee in the hospital, that he ended and was no longer her primary care. The only damning thing I can see is that he renewed a prescription of hers - which he should not have done if he wasn't her primary care any longer. Nobody should be judged by ONE personal indiscretion in their past. If that was the case, most everyone would be in trouble. The incident was brought up at the time to the chief of the hospital, who, obviously, didn't have an issue with it, so it begs the question: why now? Why bring up a settled issue 6 years later?
I am heartbroken to lose my cardiologist but it does not change my view of him as a doctor or person.
In this day and age, nothing is ever black and white. There are extenuating circumstances that should be examined. I hope he wins his appeal. I will gladly go back to him!

Jim Sabin said...

Dear Anonymous -

Since this is a topic I've discussed a lot on this blog and since you've given it careful personal thought, I'd be very interested in hearing from you again in the future.

Whatever "good luck" consists of in your situation, I want to wish it to you.

Best

Jim

Jim Sabin said...

Dear Anonymous former patient of Dr. Brockington -

A number of Dr. Brockington's patients and former colleagues have spoken about him in the same vein. If the facts are as presented in the Boston Globe article, I share your hope that he wins his appeal.

Best

Jim