Saturday, December 22, 2012

Plastic Surgeon-Patient Sex

I recently received these questions about doctor-patient sex with a plastic surgeon:
My married sister's plastic surgeon called to give his condolences after the passing of our father. The doctor continued to call and fostered a personal friendship with her. He started to confide in her about his marital problems. They arranged to meet for dinner and entered into a 18 month affair. When my brother in-law discovered the affair, the doctor quickly abandoned her and started to make her look like the person who wanted the affair. My brother in-law filed an ethics complaint which is under investigation for over a year. I am the only person my sister will discuss the affair with, but not the only person that can see how the affair has affected her mentally. She is extremely depressed, filled with guilt and shame and has talked to me about ending her life. She refuses therapy, so I do the best I can to help her. Lately because of our conversations, I truly feel he took advantage of a vulnerable patient who was depressed over the loss of her father. She told me she had become dependent on him. Can you explain this dependence? She says she now knows how people follow a cult leader. Her pain is real and the result of a consensual affair with her doctor. He is not a mental health doctor; will he be held to the same standard? (emphasis added)
 In my response I emphasized that how important it was to help the patient accept counseling. Here I want to discuss the question of whether the plastic surgeon would be held to the same ethical standard as a psychiatrist.

To my eye, although the code of ethics for the plastic surgery specialty prohibits "sexual misconduct," it defines the term in a way that leaves patients and the profession vulnerable:
Sexual or romantic relationships with current or former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the current or previous professional relationship.
The relationship between plastic surgeon and patient is intensely personal as well as technically demanding. Especially for surgery with aesthetic aims, patients entrust the surgeon with potential for making them look more the way they dream of appearing. For female patients, interventions may involve face, breasts, genitals, and their overall sense of "desirability." In terms of the question the patient's sister posed to me - the doctor-patient relationship in plastic surgery would seem to have all of the key characteristics that occur in mental health practice: exposure of deeply personal concerns, potential idealization of the clinician as a "saviour," and "transference" of feelings from the past. And, unlike psychiatry, ordinary practice involves disrobing and touching.

It's hard to see how a "sexual or romantic relationship" between plastic surgeon and patient would not draw in "trust, knowledge, emotions, or influence" derived from the professional relationship, whether or not the physician is consciously "using" or "exploiting" those factors. Even if passions are not involved, it would be very difficult to ascertain whether the factors the code of ethics prohibits were present. Sexual attraction and feelings of love are not known for inducing heightened intellectual and analytic lucidity!

I was unable to find any data on the frequency of complaints about sexual/romantic relationships between patients and their plastic surgeons. Unfortunately, a review of five years of complaints made to the ethics committee of the professional association did not report on the specific content of the complaints. But in light of the nature of the patient-doctor relationship in plastic surgery, I believe that the position of the American Psychiatric Association - that sexual relationships with current or former patients are unethical - would apply with equal relevance to plastic surgery.

In answer to the question posed by the patient's sister, I could not respond that the physician would be held to the same standard as a psychiatrist, but did say that I thought that should be the case.


Anonymous said...


On december 21, 2012 I started a discussion with regards to my sister having sex with her plastic surgeon. Three events have transpired since then. The plastic surgeon was found guilty of patient abuse and morally unfit to pratice medicine. He received a $10,000 fine and 3 years loss of his medical license. He was held to the same standard as a psychiatist. as far as my sister, her husband has filed for divorce and she has had a breakdown that requires in-patienet care. We are all standing bye her, but I believe she is going to have a long road to travel. Her business is suffering and will probably fail since it is directly built around her talents. The doctor will be able to return to pratice, but my sister has lost more than a license.

Jim Sabin said...

Dear Anonymous

Thank you for this further report on your sister's situation. From what you describe it sounds as if the plastic surgeon received a severe, but fair, disciplinary response from his state medical board. But I am sorry to hear how much suffering your sister is experiencing. Unfortunately, the kind of harm she has received from the sexual/romantic relationship with her physician is not infrequent. The risk that a sexual/romantic relationship will cause that kind of harm is one of the two primary reasons that the medical profession correctly regards relationships of this kind as an unethical betrayal of professional responsibility. (The other reason is that even if the relationship causes no harm to the patient it contributes to loss of trust in the medical profession.)

Your sister is lucky to have a sister who is so concerned about her and so supportive!