"How Bad Is It REALLY to Date a Patient?"

Some years back (long before POCA Tech was around) WCA hired an acupuncturist who, after working for us a few months, wrote us an email that went something like this: “So as you might know, I’m single and I’m actively dating. Some of my patients are people who I would be interested in dating if I met them outside the clinic. And, some of these people run in the same circles I do and I see them out in the world. I was trying to remember specifically the ethics I learned in school... Honestly, while I was in school having a relationship with a patient just seemed so taboo that I never thought I would consider it. I also never came across a patient who was attractive to me. But, the more I work in a community acupuncture setting the more I think it’s almost inevitable as a single practitioner. Especially at WCA -- We have 17,000 patients on the books! (Update: as of today that number is close to 62,000). The odds are not in my favor! So...how bad is it REALLY to date a patient?”

I think of that email as a good example of why framing safety only in terms of “don’t do that thing!” isn’t enough-- you can bet your life that eventually, somebody’s going to think, yeah yeah yeah I know, but how bad is that thing REALLY?

I also think the issue of acupuncturists dating patients has some elements of a can opener bridge. The practice of acupuncture involves a certain amount of intimacy between humans, in the context of a society that’s just beginning to learn about consent, with capitalism telling us all that there’s never enough of anything good. So more flashing warning signs saying DON’T DATE YOUR PATIENTS aren’t going to help much. The goal of this post is to provide something more like a tour of the road that leads to the can opener bridge, a preview of what you can expect if you end up there, and some tips for how to find a detour.

An acupuncturist from another clinic shared this story in response our employee’s question:

“Here’s a bedtime cautionary tale from the POCAverse: patient asks a punk out. punk says oh, no, we can’t date patients, it’s unethical. patient continues to flirt, and the (lonely, new-to-town) punk says ok, i’ll go on a walk with you sometime, as a friend only. sure enough, there are sparks, and the punk states that she can date the patient 6 mos. later, if she ceases to provide care, refers him out of the clinic, and if they wait awhile. punk does all these things, and the patient accepts the terms. she retires his chart, and the remaining 2 treatments on his punch card. 6 months ends up being more like 3 weeks, and they sleep together and date for several months. they have a terrible breakup and the punk sees just how troubled her former patient actually is. he disappears and she picks up the pieces of her shattered nerves.

ABOUT 6 MONTHS LATER, patient reappears, questioning the whereabouts of his remaining treatments on the punch card, and what could he do with those? punk offers for him to use them up seeing the other punk on staff. he swears it’s a full punch card (7)—it’s actually only 2, but he is insistent that she is lying, and he wants a full monetary refund now of all 7 treatments!—which he is saying is worth $140. he emphasizes that he knows that the punk was doing something unethical when she dated him, and that if he didn’t get $140, he would be contacting the state licensing board promptly with his allegations of her professional misconduct. punk is completely shaken, and while would love to point out the finer details like what he is doing is BLACKMAIL and extortion, she realizes that $140 is a cheap price to pay to get rid of this nightmare. it’s a pricey lesson to learn, and hell, an expensive lay, and surely not worth the anxiety and many hours of sleep lost. it’s petrifying to know that someone knows exactly where you work, during exactly which hours… wherein community members are trusting in the safety of the shared community space. she paid him the money on the condition that he would never, ever contact her or the clinic again, would never step foot in the building, and he agreed, and he hasn’t.”

And just in case anybody wants to take this story as evidence that even though that sounded very stressful for the acupuncturist in question, things worked out in the end, right? -- let me share a similar story in which they didn’t.

An acupuncturist who worked occasionally as a sub for a busy community acupuncture clinic had a day job doing public health acupuncture. He made a series of “life-altering bad decisions” (his words) and engaged in a sexual relationship with one of his public health patients. He was married, and his wife didn’t know. When he broke up with his patient (having decided the affair wasn’t working out for him), she didn’t go away quietly, she exploded. Hell hath no fury, etc. She not only turned him into the acupuncture licensing board for unprofessional conduct, she commenced stalking him on social media -- but not only him, but also his wife and any clinic that ever employed him. A year later, he surrendered his acupuncture license because even if the licensing board gave him another chance (they probably would have, it was his first transgression) there was no way to resurrect his career. Because his ex-lover was/is determined to make sure he’ll never have another acupuncture job.

Dating patients means participating in some dangerous power dynamics, for both the practitioner and the patient. Whether you mean to or not, a sexual relationship between you and your patient involves a dynamic in which you have more social power than they do, which makes consent questionable; and by engaging in a prohibited relationship, you’re offering the other person a certain kind of power over you.

And because this isn’t enough of a tangled knot already, let’s add another strand: some acupuncture licensing bodies -- including Oregon’s -- have a requirement that their licensees must report another licensee who’s engaging in this kind of relationship. “A licensee who has reasonable cause to believe another health care professional has engaged in prohibited or unprofessional conduct must report the conduct to the board responsible for that person, per ORS 677.092, ORS 676.150(2), ORS 676.150(5), OAR 847-010-0073(1). Unprofessional conduct, as defined in OAR 847-010-0073(3)(b)(G), includes sexual misconduct.” In other words, if you date your patient, any of your licensed colleagues or coworkers are obligated to report you if they know about it. If there’s an investigation -- as there was with the unfortunate acupuncturist in the second cautionary tale -- any licensed colleagues or coworkers who knew about the relationship can end up in trouble as well.

So obviously, dating patients represents a lot of risk for everyone involved, including any bystanders who happen to have licenses.

Beyond these risks, though, the most important reasons not to date patients are safety-positive ones. Acupuncturists need boundaries, self-care, and social safety not just to stay out of trouble with their licensing body (which of course is important in its own right) but to do their very demanding job of being present for other people in pain, day in and day out. In hindsight, the acupuncturists in the cautionary tales ran into problems with maintaining boundaries, doing self care, and cultivating social safety. They made choices that weren’t good for them or their practices in the long run. Dating their patients was more of a consequence of these lapses than a cause.

As noted in this post, you need boundaries if you want to create a patient base that’s big enough and stable enough to support your livelihood. A key aspect of doing that is having consistency in all your patient relationships. If you have a relationship with a patient that varies a lot from the baseline of all your other relationships with patients, it will affect the vibe of the clinic, and not in a good way.

A community acupuncturist who trained as a minister noted, “One of the most helpful things I was taught is to be mindful about how you are preparing for work. If you are thinking about what you are going to wear when you see a certain patient, all sorts of warning bells should be going off in your head.” Similarly, if you notice that your communication with a certain patient is very different from your communication with all your other patients, that’s a sign that your consistency is slipping and more risk is entering the picture.

Although the email from the WCA acupuncturist complaining that the size of WCA’s patient base was interfering with their dating prospects made us roll our eyes, it was also a valuable, safety-positive gesture. The acupuncturist communicated that they didn’t understand a boundary, which is a million times better than not communicating. They reached out and asked for help. This is the most important thing to do if you find yourself struggling with any boundary in your practice, not just the boundary that designates patients as off-limits for dating: connect with another human who can provide support without judgement while you work on getting clarity for yourself.

And if you never struggle with any boundaries in your practice, you’re very lucky -- AND you can make a valuable contribution to a culture of safety by being the supportive, nonjudgemental person that other people can call on for assistance when they’re struggling. You can help create safety by being willing to have neutral, non-shaming conversations about boundaries and how hard it is to be human sometimes. Safety is always a cooperative project.