practice partner
office consult
The purpose of this column is to answer questions about issues that we either hear about frequently, or that
have a wide applicability across the profession. If you have any questions or topic suggestions for this column,
please email them to feedback@cpso.on.ca, or contact the Physician Advisory Service.
Hiring patients
may compromise
physician-patient
relationship
photo: istockphoto.com
O
ccasionally, we receive inquiries from
physicians regarding the appropriateness
of hiring a patient as an employee. Based
on the inquiries we have received, the
employment context can be vast and includes employing patients in a variety of settings, including office
staff, assistants, accountants, house cleaners, babysitters,
and lawyers, for example.
While this may seem like a worthwhile opportunity
for both parties since there is already an established level
of trust inherent in the physician-patient relationship,
the College advises against physicians hiring patients in
any capacity.
The physician-patient relationship is the foundation of the practice of medicine. It is critical that the
patient’s best interests always be paramount. But this
may conflict with the physician’s role as employer.
Maintaining appropriate boundaries, avoiding conflicts
of interest, and ensuring the privacy and confidentiality of personal health information are all examples of
obligations that could be potentially compromised by a
concurrent employer-employee relationship.
As described in the College’s Maintaining Appropriate Boundaries and Preventing Sexual Abuse policy,
physicians are required to establish and maintain appropriate professional boundaries with patients. This is critically important because a power imbalance exists in the
physician-patient relationship that favours the physician.
In order to receive care, patients provide information of
a sensitive nature about themselves or family members.
When a patient is also an employee of the physician,
this can make it uncomfortable or even difficult for the
patient/employee to share sensitive information. Furthermore, when an employer-employee relationship is
created with a patient, this can compromise the physician’s emotional and clinical objectivity, which may make
it difficult for the physician to meet the standard of care.
This can then potentially affect the quality of treatment
the physician provides for the patient.
The rationale is much the same for not treating self
and family members. As set out in the College’s Treating Self and Family Members policy, the quality of
the physician-patient relationship can be compromised
where there is a personal, professional, or emotional
relationship beyond that of the doctor-patient relationship. While there may appear to be advantages to
hiring a patient, it may also be bad medicine. For these
reasons, the College advises against hiring a patient as
an employee.
Indeed, the College also advises physicians not to
enter into any business arrangement or contract with a
patient. A patient may feel pressured to enter into such
a transaction with their physician out of concern that
their refusal might jeopardize their relationship with the
physician or the quality of care they will receive.
For further information on this topic, or for any other
practice-related question, please contact the Physician
Advisory Service at (416) 967-2603 or 1-800-268-7096
extension 603. You can also email us at feedback@cpso.
on.ca.
Issue 3, 2015 Dialogue
47