Wednesday, February 11, 2015

A Check-Up with a Side of Romance: Personal Relationships and the Medical Profession in the Movie Waitress

Two of my areas of study are Philosophy of Sex and Love and Bioethics. It isn’t surprising then that the issue of crossing boundaries in patient/physician relationships is one of particular interest to me. In the film Waitress, this issue is raised because Jenna, an emotionally abused wife who desires to leave her husband, finds herself with an unwanted pregnancy.  For a variety of reasons, she becomes attracted to the new doctor in her small town and begins an illicit affair with him that ends only when she’s delivered her husband’s baby.

The movie illustrates a variety of relationship realities – one of the other waitresses is in a marriage that has lost its spark due to her husband’s health problems and finds herself having an affair with someone no one would have expected.  Another winds up in a relationship with an unattractive man who is well beyond zealous in his proclamations of love.  The movie seems to highlight the involuntary and spontaneous nature of love, showing how it happens unintentionally and in ways we would not have planned.  The majority of relationships in the film are shown as examples of how this spontaneity can be positive and life-affirming. However, the relationship between Jenna and Dr. Pomatter is problematic because of its spontaneous and unintentional character. Both participants are married and both have other plans that are threatened by their participation in this relationship.

The point that I wanted to consider more carefully, however, is the way in which Jenna and Dr. Pomatter’s relationship might be considered a professional violation. It is common sense to think that a physician engaging a patient in a romantic relationship is fraught with ethical trouble. Unfortunately for Dr. Pomatter, it seems that his desire to be accommodating to his patient’s needs (he agrees to see Jenna outside of normal business hours) and responsive to her personal difficulties (he shows sympathy regarding her personal situation and how it complicates her pregnancy) is what creates this unethical romantic entanglement.

Can we fault Dr. Pomatter for his kindness and flexibility given our social expectations regarding the prohibition against physician/patient relationships? 

Should we hold him accountable for how his choices ultimately resulted in a romance that he did not predict or desire? 

I think the answers to both of these questions are yes.  Let’s completely set aside the fact that both parties in this particular relationship are married – a point that distracts from the other issues this case raises. There are reasons why medical professional have expectations regarding having chaperones present during sensitive examinations and these expectations do not simply apply in situations where there is a reason to predict a potential problem. The patient’s safety and the physician’s reputation require that precautions are taken in all cases. Furthermore, because Dr. Pomatter is acting as the authority in this interaction, I contend that he is singularly responsible for the problematic relationship that resulted. I hold this in spite of the fact that Jenna, the patient, initiated both their interactions with a gift. While some might hold that gift-giving is a violation of the professional relationship, the fact that the initial gift (a pie) could not have been intended as manipulative or seeking the favor of a young, attractive doctor (as she did not realize that she would be seeing Dr. Pomatter) indicates that Jenna was not attempting to engage in any kind of misconduct. In fact, it may have been detrimental to Jenna and Dr. Pomatter’s working relationship if he had turned down the tarts. They were of very little value, it is unlikely that they would have introduced any kind of expectation of reciprocity into the patient/physician interaction and most likely Jenna would have taken offense that may have made their dealings awkward. This is a very small town, after all, and the expectation of politeness and kindness is ever-present.
But it is the very fact that they are in a small town that I think complicates matters. So far, nothing that has been said here is ground-breaking. Physicians and patients are discouraged from personal relationships and we generally hold the physician accountable for maintaining a professional distance. That said, I wonder if this is a reasonable expectation when those involved are living in relatively close-proximity to each other. When another physician is not to be found for miles, there may be little or no alternative for patients seeking treatment. This certainly seems to be the case for poor Jenna who is limited in her transportation by her husband. Additionally, it is that close-proximity that is likely to create the space for personal relationships to take place. For Jenna and Dr. Pomatter this is not an issue, their relationship is not generated by repeatedly running into each other at the market, but for practicing physicians and other medical professionals who operate with this expectation of professional distance and who live and work in rural areas, this is a genuine concern. Let us consider the alternative are available in these circumstances and the reasonableness of each.

First, Dr. Pomatter could place a prohibition on all personal relationships in the town. Presumably, a romantic relationship is going to be more likely to create conflicts of interest than a friendship but that doesn’t mean that a particularly close friendship couldn’t create them, just the same. Consequently, this would mean asking all medical professionals practicing in rural areas to rule out having a social life in any kind of meaningful way. Given the shortage of rural doctors, it seems unreasonable to place another burden on this already burdened population.

Second, Dr. Pomatter could be required not to live in the town in which he practices.  Again, this creates more problems than it solves in that it may not be reasonable to place restrictions on the housing arrangements when a medical professional is hired. There may be other constraints that require them to live where they do – availability of schools for their children or work opportunities for spouses (a point that would be an issue if we broaden the scope of this issue to all personal relationships – not just romantic ones). Furthermore, in areas of particular geographic distance between towns, it simply may not be practical to have the nearest medical professional living a town or two away and in areas where towns form communities in spite of geographic distance, setting up house in another town may just be a technicality – especially if the medical professional continues to shop, worship or recreate in the town in which he works. And it seems well-beyond the reasonable scope of expectations to place limits on these aspects of a physician’s life.

Both of these alternatives place the burden of policing personal relationships on the physician, and I believe this is where it ought to be. However, if we were to shift the responsibility to the patient, the options are not much better. Jenna could be responsible for finding another doctor (an option we’ve already pointed out isn’t practical in her case) or she could be responsible for limiting personal interactions with her physician. While common sense would tell most people to avoid a romantic relationship with their physician, it would not be surprising to find that few people could clearly articulate why. They might mention conflicts of interest or bad decision-making, but given that no one is trained in how to interact with their physician, it simply makes more sense to put the burden of responsibility on the physician – who is trained in proper interactions with patients.

However, this brings us back to options one and two, neither of which seemed particularly reasonable. For this reason, I would argue that it may not make sense to rule out physician/patient relationships, or perhaps more appropriately, any medical professional’s relationship with his/her patients. While there may be an asymmetry to the relationship in terms of power and knowledge, this can be true of a variety of relationships and unhealthy relationships are going to manifest their problems in a variety of ways. Consequently, rather than a prohibition on such relationships, the expectation should be clear communication, reasoned decision making and informed consent – expectations we would place on any interaction between a medical professional and his/her patient. In this case, Dr. Pomatter would be off the hook.

Mrs. Pomatter may disagree. 

-Jessica Gosnell

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