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Monday, 16 August 2010

Doctor-Patient Sex and Quality of Care

The Providence (Rhode Island) Journal blog reported that Dr. Brian Kwetkowski, a family physician, relinquished his medical license after it was revealed that he had conducted a three-year affair with a patient. The affair started when the patient was 19.

I found the comments about the blog post fascinating. I've copied them here, with my own comments written in bold italics:
Ernie said: "Doctors have affairs with their patients all the time in soap operas. Dr. Kwetkowski should apply as a soap opera actor now that he's done this in real life." (I don't follow soap operas, but it would be interesting to know how these affairs are handled. Is the exam room presented as an acceptable boy meets girl/boy meets boy/girl meets girl venue? If so it would make for good soap drama but terrible public education about professional ethics.)

Providence said: "Why did the guy have to turn in his license? She was over 18 - old enough to consent to a relationship. Maybe that "relationships" law needs to be reconsidered. Doctors can fall in love with patients, can't they?" (Providence is right - Doctors can fall in love with their patients, with "can" meaning that (a) love feelings occur and (b) love feelings aren't morally reprehensible. The moral issue isn't what a physician feels, but what the physician does. I agree with Providence that a 19-year old is entitled to "consent" (or to "initiate"). But in my view, and the prevailing view of the medical profession and licensure boards, the physician is not allowed to be part of a sexual relationship with a patient.)

A Patient said: "my opinion to this is (and I have every right to it! - that the female patient is and was an adult when this started and this obviously was consensual. I hate the fact that I'm loosing the one doctor that really meant a great deal to me and my family all because of this. How many doctors or any other professionals out there has had an affair, big friggin'deal! It's their life and they shall do with it as they will, who are we to judge?? It is none of our business. That mother should just deal with the fact that her daughter did this as an adult and mommy should have dealt with the daughter. What skeletons are hiding in your closet? Shall someone probe into your life? Or is mommy just looking for a financial boost in her bank account?" (Dr. Kwetkowski's patient makes several important points here: (1) If we knew the facts we might conclude that the affair was indeed consensual. It would be condescending to assume that the affair must have been exploitative. (2) The patient sees no basis for the ethical perspective I argued for in a recent post - that sexual relationships with patients are wrong quite apart from whether the patient is harmed. The patient appears to be putting what I see as a professional relationship that entails distinctive obligations into the framework of market exchange between consenting adults, within which anything the two parties agree to is OK. (3) The patient invokes a teaching I agree with - "let he or she who is without sin cast the first stone." I do not conclude from the fact of the affair that Dr. Kwetkowski is an evil human being, but I do conclude that he violated his ethical responsibilities as a physician. (4) The patient reports having received excellent care from Dr. Kwetkowski. There's no reason to doubt this.)

Linda Tente said: "Dr. Briam Kwetowski is my phsician. He has been my doctor since 2001. He is the most efficient, knowledgeable, honest, trustworthy, caring humanitarian and family doctor anyone could know. I can't imagine having anyone else as my doctor. I don't know the circumstances that put him in this awkward position, but I do know the public does not have to be protected against him. My God he saves lives and families. He heals and protects his patients. Who of us has lived our lives without personal indiscretions? This does not impact his ability to uphold the Hippocratic oath. Dr K hold your head high. I am sure once all the details are disclosed you will be vindicated. Me and my family cannot wait for this to be cleared up and you return to your office. I am proud to know you and be your friend as well as one of your loyal patients. Stay well!" (This is a very important comment. It amplifies the previous patient's praise of Dr. Kwetkowski. There's no reason to doubt that a physician who, like Dr. Kwetkowski, violates the prohibition of sexual relationships with patients might provide superb care to his other patients. Apparently that was true for Dr. Kwetkowski.)
I don't know if Dr. Kwetkowski has lost his license on a permanent basis. If I had been on the Rhode Island Board of Licensure I would have wanted to know more about the history of his practice. Was this affair a solitary event, or did he have a pattern of sexual involvement with patients? If it was a pattern I would have favored permanent loss of licensure. If it was a single event, if his practice performance was otherwise commendable, and if other factors suggested that he was capable of upholding professional expectations in the future, I would have been open to a time-limited suspension of licensure, followed by a supervised return to practice.


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