Wrong for Physicians to Have Business Relationship with Patients

The suspension of an Ontario doctor for soliciting more than $700,000 in loans from his patients underscores how wrong it is for physicians to enter into any sort of business relationship with people in their care, says Elyse Sunshine. “Patients are not your bankers, They’re not your business colleagues.”

A disciplinary panel of the College of Physicians and Surgeons of Ontario suspended the medical licence of Dr. Mirza Rajabali Virani, 67, for eight months and ordered him to take an ethics course, reports the Canadian Press.

The Markham family physician had pleaded guilty to professional misconduct, admitting to soliciting a series of loans and purported business investments worth more than $700,000 from two long-standing patients, says the article.

The disciplinary panel found that Virani violated professional boundaries by using his patients’ financial information, which he learned while treating them, to try to further his own financial interests. He capitalized on the power imbalance between himself and his patients, heightened by the high status and immense trust he enjoyed as a physician in the Canadian-Iranian community to which they all belonged, says the article. The college panel "found that to be particularly problematic and despicable,” Sunshine says.

She says that although this case is an extreme example, health professionals will always be viewed as having a power imbalance with patients. “Any sort of business relationship with a patient is very likely to be viewed as a boundary violation,” she says.

Health professionals have to be careful, even when accepting seemingly innocent gifts, she says.“I don’t think anyone would view it as problematic to accept, for example, a box of chocolates at Christmas time from a patient,” she says. But it’s a slippery slope, she adds. Though it could be rude or hurtful to reject a small present from a patient, health professionals are responsible for making sure that its acceptance is appropriate and that no professional boundaries have been crossed, she says. It is never right to seek a loan from a patient unless he or she happens to already work at the bank where you do business, Sunshine says. If the patient’s business interests align with those of the health professional, and there is a particular reason to pursue a business relationship, a health professional would be well advised to refer the patient to a colleague and discontinue the treating relationship, and then to wait for a period of time before pursuing the business relationship.

Doctors have traditionally been revered in our society, and although that may generally be less true today than in the past, Sunshine says, some patients still revere their physicians. This deference is heightened in certain communities where being asked to participate in a business venture with a doctor, as in this case, would be concerning because of the fact the person requesting the loan is of the same background and is a physician – and these facts increases the level of trust the patient places in the physician and influences the decision to participate in the venture, she adds. The eight-month suspension Virani received is significant, she says. “That’s not a slap on the wrist, by any means.” Complete revocation of a doctor’s licence is reserved for the worst possible cases or where the panel believes the professional is just not redeemable, Sunshine says. In Virani’s case, he pleaded guilty to the charges and there is no evidence that his clinical care or abilities have been affected, she says. The panel likely takes the view that the ethics course will assist him in his rehabilitation and will protect the public from further exploitation, Sunshine adds.

He was sued by one of the two patients and Virani declared bankruptcy. Once the bankruptcy expires in August 2017, he will have repaid a total of only $69,000 to the men, says the wire service.

Had Virani agreed to repay the money beyond this relatively small amount, the disciplinary panel would likely have found that to be a persuasive factor in mitigating his sentence, Sunshine says.