Medical students, residents and staff alike have found themselves in conversations with patients about non-medical topics. But what happens when those topics of conversation become too personal? Please join us in discussing the case of the flirtatious patient. We would appreciate your thoughts and advice.

SMACC

P.S. Teresa Chan, Brent Thoma, Sarah Luckett-Gatopoulos, and I would also like to invite you all to register for the ALiEM MEdIC pre-conference workshop at SMACC.  Come out and be part of a LIVE version of the ALiEM MEdIC case development and release for a special SMACC version of the case series!

MEdIC Series: The Concept

Inspired by the Harvard Business Review Cases and initially led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month, we pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses are be made available for download in PDF format – feel free to use them! If you’re a medical educator with a pedagogical problem, we want to get you a MEdIC. Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching to the next level.

The Case of the Flirtatious Patient

by Izzy Colmers (@izzycolmers)

Half way through clerkship, Rachel was finally feeling like she had hit her stride. The past few weeks of her rural placement had involved periodic visits to the emergency department, which made her feel right at home. She had been doing well and her preceptor was giving her more and more independence.

So far, this particular Thursday afternoon had been uneventful. She was in the department, and was seeing a steady stream of patients. The next chart she picked up was an elbow laceration that required suturing. ‘Perfect’, she thought, ‘I’ve assisted a few laceration repairs with my preceptor. I’ll try to do this one on my own!’

The patient, Rory, was a friendly, athletic young man her age. From the triage note, Rachel noted that he had fallen while rock climbing and landed awkwardly, glancing his forearm on the edge of a sharp rock. Luckily, this was his only injury.

“You know,” said Rachel, “You need a better story… You should probably tell people you jumped out into traffic to save a puppy or something.”

“Hmmm… Would that work better with the ladies you think?” asked Rory, raising a quizzical eyebrow. “You know, a lonely single guy like me can use all the help he can get…”

Rachel smiled, and excused herself to go and review the case. A few minutes later, she re-entered the room with her attending, Dr. Richards. Rachel glowed with excitement as Dr. Richards viewed the wound and fully endorsed her plan for wound management.

“I’ll be around if you need me, just ask one of the nurses to get me if you want my help. I am pretty confident you should be fine on your own though,“ he stated, patting Rachel on the shoulder and exiting the room.

In the next few minutes, Rachel mentally walked herself through the procedure steps and prepared supplies, Rory made several attempts to make small talk.

“So, I haven’t seen you around much,” he stated. “Have you worked here very long?”

Rachel explained a bit about her rural placement, and explained that she was hoping to become an emergency physician. Rory then proceeded to ask more questions about her life, and these questions seemed to fill the awkward silence as she cautiously set up her little surgical field, so she kept answering. To be honest, she also felt a bit indebted to the patient who was allowing her to ‘practice’ on him, so she continued to oblige him in polite conversation.

As she was debriding and suturing, he continued the chat. He begun asking her about where she was from, what she liked to do outside of school, the type of music she listened to. They had lots of common interests, it turned out…Rock climbing, being one of them. She was enjoying the conversation, but not until she was bandaging up, did she realize she had been so focused on the suturing, she hadn’t noticed how personal the conversation had become until Rory’s final question:

“Hey, so, will you be around in 7 days when I need these stitches out? Or, really, any other time between now and then? I would really like to see you again…”

Aware of how inappropriate this was, Rachel muttered nervously about needing to get Dr. Richards to look at the stitches again, and quickly jetted out of the room.

Susan, the charge nurse saw the concerned look on Rachel’s face as she exited the suture room.

“Hey there,” she asked, “Are you okay? Are you feeling faint from the blood? You should sit.”

Rachel shook her head, and then explained everything to Susan. “It sounds like the cute guy you were fixing up was flirting with you. You’re single, you should go for it!”

Key Questions

by Tamara McColl (@mccoll_tamara)

  1. As a colleague or attending physician, how would you counsel Rachel about this interaction with her patient?
  2. Despite the longstanding argument that the balance of power in the physician-patient relationship is skewed towards the physician, is it ever acceptable for a physician to develop a romantic relationship with a patient? Are there any differences between primary care and emergency care type relationships and does this make a difference?
  3. The physician-patient relationship is the basic foundation of medical care, dating back to the times of Hippocrates. How has the physician-patient relationship evolved in modern medicine and has this improved trust, compliance and ultimately patient care?

Weekly Wrap Up

As always, we posted the expert responses and a curated commentary derived from the community responses one week after the case was published. This time the two experts are:

  • Dr. Merril Pauls is an Associate Professor of Emergency Physician at the University of Manitoba. He has a Masters in Health Sciences (Bioethics) and is currently the co-director of the medical school Professionalism Course and director of the pre-clerkship curriculum.
  • Dr. Kari Sampsel (@karisampsel), is an Emergency physician in Ottawa where she is the Director of the Ottawa Hospital Sexual Assault Program and where she also works as the assistant program director of the emergency medicine residency training program. She holds a diploma in Forensic Medicine from the Victorian Institute of Forensic Medicine in Melbourne, Australia.

On June 5, 2015 we will post the Expert Responses and Curated Community Commentary for the Case of The Flirtatious Patient. After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary. That said, we’d love to hear from you, so please comment below!

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

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Eve Purdy, BHSc MD

Eve Purdy, BHSc MD

Queen's University in Kingston, Ontario, Canada
Student editor at BoringEM.org
Founder of manuetcorde.org
Eve Purdy, BHSc MD

@purdy_Eve

@QEmerg resident, @UNTanthropology, humanist, dog-lover, #FOAMed and #qmed enthusiast | #ALiEMMedic | @smaccteam |