I suppose I could have been a bit more gracious in dealing with the woman in the above story, but her abrasive approach annoyed me. Another former patient, Ally, was even more persistent and, much to my chagrin, a very nice person. After I declined her offer of a date, she sent me notes, baked cookies for me, and repeated her request every time she saw me. I'm a sucker for kindness, and she was such a nice person that I had a difficult time saying no to her.

After a while, Ally began asking me why I didn't wish to date her. That made me very uneasy, because I did not feel as if I could tell her the truth—namely, that I wasn't attracted to her. I could have dealt with this by employing one of the stock deceptions such as “I already have a girlfriend,” but I deplore such dishonesty.

A year or so later, I ran into Ally and her six-year-old son in a Wal-Mart store. Perhaps I read more from his facial appearance than was warranted, but he seemed to look at me in a way that suggested, “Is this the new Dad you've been telling me so much about, Mom?”

A few seconds later, Ally asked me out again, and this time I had no white coat or telephone to hide behind. I panicked, and wondered how to respond.

“I plan on moving soon,” I explained.

“That's OK,” she countered matter-of-factly. “We'll move with you.”

Yikes, move with me? Thoroughly discombobulated, I couldn't think of any suitable truth to explain why I couldn't get involved with her, so I said that I could not date her because I met her at work. She seemed to accept this, so we said our goodbyes and departed.

Can doctors date former patients? That's a good question, and it is one of the 1001 practical topics that medical schools never cover, even though romantic sparks are bound to affect many patients and doctors. I received questions from a few readers who wondered if it was OK to date a doctor. Here is the first question:

Q: Hello Dr. Pezzi,
I recently saw a new doctor who diagnosed me with kidney stones. I think that she is quite charming. If we are both single, are there any ethical reasons why the two of us cannot date if I switch to another doctor? Thank you, Jeff

A: I researched this matter by contacting the American Medical Association. The following list presents a synopsis of their ethical guidelines and my interpretations of them:

• If a physician-patient relationship currently exists, sexual contact is unethical.

• The physician-patient relationship should be terminated before initiating a dating, romantic, or sexual relationship with that person.

In Jeff's case, there does not seem to be any ethical obstacle that would preclude dating if he is not currently being treated by that doctor.

Here is an e-mail exchange I had with another reader:

Q: I was attracted to my doctor the first time I met him. I have never before had this kind of instant attraction to any man. I think I like him so much because I really go for smart men with a compassionate side. While I am normally shy, I have managed to flirt with him a little bit. He kids with me and seems not to mind my flirting.

I guess my concern is that what I see as possible interest on his part could just be a great bedside manner. Maybe he is naturally nice to all his patients.

This would be so much easier if he were my cable guy or someone I met in a grocery store! I have so little experience in flirting and reading men for positive signals because they will approach me first. How can I tell if he really is interested? Is there anything I can do or say to let him know I want to get to know him?

By the way, I'm being treated for anemia, so it's not like I have some scary disease that would be a turn-off. Thanks, Judy

A: This is definitely a touchy situation. On one hand, you don't want to create an uncomfortable situation if he is not attracted to you. On the other hand, you do not want to pass up an opportunity for a potentially great relationship.

I assume he is not married, but he may already be involved with someone, unbeknownst to you. Assuming that he is available and attracted to you, he still may not want to become involved. Why? State medical boards frown on doctors becoming sexually involved with current patients. I exhaustively researched this matter a few years ago when another reader asked me a similar question. From what I determined, the only relatively safe course of action is for the doctor to terminate his professional relationship before he becomes personally involved. I said "relatively safe" because there is always the potential for you to raise a stink with the medical board, regardless of when he last saw you as a patient, if things don't work out and he ends the relationship. You strike me as someone who is not likely to do this, but some woman, somewhere, gave credence to the phrase "hell hath no fury like a woman scorned." In fairness to women, rejected men can be equally malevolent.

I think the most logical way to proceed is to:

1. Determine if he is available.

2. If he is available, determine if he is willing to risk dating a patient who is agreeable to becoming an ex-patient.

3. If he is willing to date an ex-patient, determine if he is interested in you.

You can do this on your own, of course, but it may be a delicate situation, as I discussed above. If you want, I will intercede on your behalf if you give me his name and e-mail address (I won't tell him your name). Thus, if he is involved with someone, or not willing to date a former patient, then you needn't go through the uncomfortable situation of telling him that you are interested.

PS: I just had another thought about your statement, "Is there anything I can do or say to let him know I want to get to know him?" Yes, there is. If you want to handle this matter on your own, you could look him in the eye, pause for effect, and then say, "I like you." If he pats you on the shoulder, gives you a perfunctory brief smile, says "I like you, too, Judy," then resumes from where he left off, it is a safe bet he is not personally interested in you. On the other hand, if he stops dead in his tracks and looks stunned, that is because he is searching for a way to let you know he is interested, without doing something that might run afoul of the state medical board.

Judy's response: I'm so glad you answered. I never thought about the potential impact on his career. That probably sounds selfish, but it just didn't cross my mind.

I've already asked an appointment clerk if the doctor is single (he's not married and is not known to be dating anyone), and I believe word got back to him. I saw him again and I think that if he isn't interested, he is definitely flattered. I believe he was giving signals of interest. He's going to call in the next couple of days with some lab results. I'm just going to take a huge risk and mention my attraction. Since it will be over the phone, I think I can get up the nerve. I will offer to see another doctor from the start so that we both have a face-saving out.

I still can't believe I am being so bold, and I hope it doesn't turn him off, but I think I'd rather know one way or the other. I appreciate your offer to contact him, but I still might chicken out, so I will hold off that for now. (I had one male friend tell me that he finds it flattering when a woman takes the initiative in breaking the ice. Do you think a lot of guys feel that way?) I'm in Alaska and up here we have to be creative when it comes to connecting with people.

I don't know whoever decided that women are more complex than men! You guys are so hard to read. Like I said, I believe this particular man was giving off signals. At least I know he wasn't repelled! J

I have to admit that I am enjoying this situation. It is both horrible and wonderful to the extreme. I will let you know what happens. Thanks so much for your response.

My reply: Please keep me posted on what happens. I am so excited for you! J

Less than two hours later, she wrote again:

If you thought I was embarrassed before, you won't believe how awful I feel now.

I spoke with my doctor a few moments ago and took the plunge. I told him that I had wanted to ask him a personal question before but had lost my nerve. Then I asked if he would ever want to get together for coffee. He hesitated, said that that was interesting. Then he said it probably wasn't a good idea since his girlfriend probably wouldn't understand. He also added that it was "very kind" of me to ask though.

I am completely embarrassed. I don't think I will have a problem seeing him again as my doctor. I will just apologize and feel like an idiot for the first few minutes. But I know that I will never take the first go again.

Anyway, I just wanted to let you know how it went. Thanks for your help. I did it and blew it, but at least I did it.

Dr. Pezzi: First, you didn't blow it. You did one of the best things that someone can do: actively pursue what they want. I (and many others, no doubt) learned this lesson the hard way. Letting opportunities pass by is a great way to ensure future “What if?” feelings. Now you don't need to ever wonder what MIGHT have happened.

It's too bad you live so far away. Otherwise, I'd take you out for coffee and cheer you up. You sound like a great person. Call it my ER intuition. In any case, I doubt that you will have any problem finding a great guy.

Judy: You're too nice. I feel so awful right now, and I needed to hear every single thing you said. I just don't know if I will be able to drink coffee for a long time now! J

Now that I know I don't have a chance with this guy, I almost wish I'd left things at the "What if" stage. Right now, I'm just dreading the next time I have to see him. I keep telling myself that at least I didn't have to look at him when he turned me down.

I've bothered you so much already, I almost hate asking you about something else: did I completely misread this guy, or could it be that he is protecting himself? At any rate, I've learned my lesson. I guess it's not very nice of me, but I can always pray that he remembers me if he and the girlfriend ever break up! (I don't really wish that on him. He is too nice of a guy.)

What's so ironic is that I actually turned down a guy who approached me in the store yesterday. I had my heart set on the doc, and couldn't even think about other guys at the time. I guess now is when I should be glad that I have work to bury myself in.

Response from Dr. Pezzi:

> . . . did I completely misread this guy, or could it be that he is protecting himself?

I don't know. It'd be easier to tell if I'd seen him interacting with you, to see if his behavior was just very pleasant/friendly/trying to be a nice doc & have patients love him, or if he was perhaps projecting stronger signals of interest.

> What's so ironic is that I actually turned down a guy who approached me in the store yesterday.

You must be beautiful! J

Judy: Hi Kevin,

Okay, so you are smart, funny, and nice. I saw the photos of you & I think you are cute. You'd better watch out—you know I fell for one doctor! J

I have decided to believe (OK, my ego believes) that he is/was interested. Maybe this just isn't a safe or comfortable situation for him right now.

I don't know about beautiful, but I don't think I am ugly (and maybe that is my ego talking again!). I don't look my age, and I know that can be more of a disadvantage than people think. ANYway—thank you for the compliment. At least I feel more beautiful after all your kindness. If you ever get to Alaska, I will have to take you for a cup of coffee.

I don't know if you want to be bothered, but I could let you know how things go when I see this guy again. I know he's probably "consulted" with his co-workers, so I expect to have a reputation when I get back to the clinic. I am going to let him know I meant no disrespect. He is a great doctor, so I hope he doesn't pawn me off to a colleague. (I just keep digging holes to crawl into, huh?)

Keep being a nice person, Kevin. You don't know how having you out there helped me through this. I was afraid I would feel intimidated by someone as smart as you, but all I feel is a lot of respect.

Thanks, Judy

Two days later, she wrote again:

How are you? It's a beautiful morning here.

I have to tell you that I thought for a very long time about something you said in your last e-mail. You commented that I must be beautiful. I honestly didn't know how to respond. I was very wary of what my response would reveal: vanity or a lack of self-esteem. I wasn't feeling so hot about myself either. Anyway, I went for a walk last night with a good friend and I asked if he thought I was physically beautiful. This guy is someone I can count on to be nice but not BS me. He told me I am beautiful, but that I can come across as being cold. I've known this man for thirteen years, so maybe he sees more in me than others. I was shocked that he sees me as coming across as “cold.” What does that say about my communication skills? My self-awareness?

I think this whole situation has been good for me in many ways. It took all I had to ask the doctor out, and now I want to be more adventurous in everything. I've allowed some friends to talk me into going on a powerboat ride up the Kenai River. That may not sound like a big deal, but I am terrified of deep water because I can't swim.

Well, I hope you stay in touch. We have almost nothing in common, but you're the only one to go through this whole experience with me, and I feel like I have made a new friend. I find myself looking forward to hearing from you.

Judy

In retrospect, I wonder if the “I have a girlfriend” excuse given by Judy's doctor was valid, or just a convenient way out of an uncomfortable situation? Later in the book, I'll present a case in which a beautiful young woman (a patient's granddaughter) handed me a note in the ER making it very clear that she was interested in me. For guys who are as plain as I am, such events happen once in a lifetime, if that. Did I call her, as she requested? I did not have a girlfriend then, and I wanted her as much as a man lost in the desert wants a glass of water. However, at that time I did not have any ethical guidelines to help me decide if it were permissible to date her, so I didn't call. Judging from what I know now, I think that I was being overly cautious. Perhaps Judy's doc was equally perplexed about this ethical matter, so he (like many doctors) chose the safe response.

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