A 57-year-old woman comes to the office for routine follow-up; she has been a patient of the physician for 20 years. She has a history of chronic obstructive pulmonary disease (COPD), hypertension, and type 2 diabetes mellitus. The patient was hospitalized for a COPD exacerbation 4 months ago, but she has done well since. Her husband, who was also a patient of the physician, died 2 years ago of pancreatic cancer. During the visit, the patient happily informs the physician that she finally quit smoking and that she is getting married to a man she met 3 months ago. She says, "You can't imagine how happy I am. You have known me for so long and have seen me through some terrible times. It would be a great honor if you would attend my wedding." Which of the following is the most appropriate response to the patient?

Question

A 57-year-old woman comes to the office for routine follow-up; she has been a patient of the physician for 20 years.  She has a history of chronic obstructive pulmonary disease (COPD), hypertension, and type 2 diabetes mellitus.  The patient was hospitalized for a COPD exacerbation 4 months ago, but she has done well since.  Her husband, who was also a patient of the physician, died 2 years ago of pancreatic cancer.  During the visit, the patient happily informs the physician that she finally quit smoking and that she is getting married to a man she met 3 months ago.  She says, "You can't imagine how happy I am.  You have known me for so long and have seen me through some terrible times.  It would be a great honor if you would attend my wedding."  Which of the following is the most appropriate response to the patient?

Quizplus · Accepted Answer

Explanation: This physician is confronted with responding to an unexpected wedding invitation from a longtime patient. Although there are clear ethical rules against sexual relationships with patients, there are no specific guidelines regarding social contact outside the professional relationship. Some situations are clearly inappropriate (eg, meeting a patient for dinner, planning a vacation together). Others, such as an invitation to a major life event, are more ambiguous. Physicians must use their clinical judgment to respond in a manner that is courteous, respectful, and minimizes potential harm to the patient (ie, principle of nonmaleficence). Cultural factors and the physician's personal values may also inform the decision of whether to attend. Some physicians will be comfortable in such settings, whereas others will prefer to keep professional responsibilities completely separate from their personal lives. If the physician declines the invitation, the response should contain an empathic expression of appreciation for the invitation and polite regrets. (Choices A and D) These statements show appreciation for the invitation but are unnecessarily judgmental and may make the patient feel uncomfortable for having asked. (Choice B) The patient is not asking the physician for advice. It would be inappropriate to offer advice unless there is reasonable cause for concern about the patient's welfare. (Choice C) The medical code of ethics does not prohibit physicians from attending a patient's wedding. Educational objective: Accepting a longtime patient's invitation to a significant life event does not violate ethical professional boundaries. Physicians must use professional judgment and cultural sensitivity in responding to social situations outside the professional relationship. References: Management of professional boundaries in rural practice. (http://www.ncbi.nlm.nih.gov/pubmed/22722347) Managing professional boundaries. (http://www.ncbi.nlm.nih.gov/pubmed/24024230)

A 57-Year-Old Woman Comes to the Office for Routine Follow-Up;