THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved. In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Is flirting with clients taboo?’, is presented and discussed by Steven McCulloch. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘Rodents’ rights: patients or pet food?', which was published in the March issue of In Practice, appears on page 223.
The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.
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Steven McCulloch graduated from the University of Bristol in 2002. Since then, he has worked in small animal practices in the UK and Hong Kong. He holds a BA in philosophy from the University of London and is currently working towards a PhD in veterinary and agricultural ethics at the Royal Veterinary College.
Issues to consider
In writing this piece I searched the Internet for ‘the 3Fs rule for communication’. It seems the 3Fs have various definitions: the first hit was ‘The Christian Blonde: a blonde believer's guide to faith, fashion and all things fabulous’. Despite this, it is useful to discuss the nature of a veterinary surgeon and the limits of reasonable professional communication and behaviour. Indeed, the 3Fs discussed in the training session will, no doubt, be very useful in some domains of business – sales particularly comes to mind. Who hasn't bought something off a flirtatious salesperson and then felt a little used as the salesperson moves onto the next customer? Even the move to swap strategies two and three for gay people makes sense, although it could be a disaster.
You are attending a management training session and are advised to follow a 3Fs rule for successful communication: be fun with children, be friendly with clients of the same sex, and be flirtatious with clients of the opposite sex. It is also suggested that you could swap the second and third strategies when talking to clients who are gay. Is flirtation just human nature and is it ethical in practice?
So is there a problem with flirtation in practice? Surely a little coquettishness never hurt anyone? First, what precisely is flirting, since this is our principle concern? A quick search yields ‘to behave as though attracted to or trying to attract someone, but without serious intentions’. Actually, I would go further; one can flirt in order to woo someone; therefore, the intentions can also be serious. So flirting might or might not have serious intentions and, in essence, is about biological attraction.
We should also consider the acceptability of flirtation in sales but not in other professions or, at least, not in caring professions. The salesperson's raison d'être is to sell and, within reason, ‘what sells goes’ (morally speaking). A veterinary surgeon, though, is different; our raison d'être is not to sell, but something quite different. In sum, it is encapsulated in the declaration: ‘I promise and solemnly declare that I will pursue the work of my profession with integrity and accept my responsibilities to the public, my clients, the profession and the Royal College of Veterinary Surgeons, and that, above all, my constant endeavour will be to ensure the health and welfare of animals committed to my care.’
So we, veterinary surgeons, should act with integrity. Consider some youthful veterinary colleagues who read the RCVS Code of Conduct after attending a training course advocating these 3Fs. Will they bite of the apple of flirtation? The Code states veterinarians should act with ‘honesty and integrity’, ‘independence and impartiality’, and ‘client confidentiality and trust’. Our young and impressionable vets might still be tempted by the 3Fs mantra, but I suspect talk of integrity and duties might make them double take before they double entendre. So what next?
Possible way forward
The root of the problem seems to be that this sort of behaviour is not suitable for the vet-client relationship. The vet is in a position of power over the client, so there is an inherent potential to abuse that power. Thus a professional code of conduct demarcates boundaries of professional behaviour that ought not to be crossed, since this risks harming the client that the professional serves.
Now, with respect to the dangers of flirtation, these issues are not spelled out in the RCVS Code. Despite this, and for good reason, the General Medical Council's (GMC) Good Medical Practice devotes a section to the issue: ‘In order to maintain professional boundaries and the trust of patients and the public you must never make a sexual advance towards a patient nor display “sexualised behaviour”. Sexualised behaviour has been defined as “acts, words or behaviour designed or intended to arouse or gratify sexual impulses and desires”.’
Here, the seemingly innocent problem of flirting in a professional context is prohibited. In the GMC we have a fully worked out definition of ‘sexualised behaviour’. Worryingly for those trainees who might be tempted towards the third F, the ‘behaving as though trying to attract someone’ seems very close indeed to ‘intending to arouse sexual … desires’.
It could be argued that the doctor-patient relationship is different in kind to the vet-owner relationship, but in both the potential for professionals to abuse their power over possibly emotional and dependant patients/clients is ever-present. Perhaps it is more acute when the relationship between the healer and the client is a direct one, as in human health care, but the necessary elements are there in our profession as well.
So I'll lay my cards on the table with these 3Fs by modifying the framework to make it professionally acceptable, although somewhat insufficient. Following the same structure, I would be fun with children, friendly with clients of both sexes and non-flirtatious with clients regardless of sex. Hence, it becomes an awkward 2Fs and a 1N, but at least you won't get into trouble with the RCVS. My justification is that making veterinary medicine fun for children is fine. A consulting room is a great place to introduce kids to science and I regularly do. Friendliness is also OK and, in most circumstances, good, but it needs to be universal. However, to spoil the party, I claim that flirtation (with either sex) is a risky business and, moreover, inconsistent with professional behaviour.
To end, why have I contemplated this scenario, since when I searched the Internet for the 3Fs The Christian Blonde (faith, fashion and all things fabulous) came up and not the RCVS Code of Professional Conduct? Because I do think it is human nature – no matter how problematic the notion – to flirt with people. If this is true, then the veterinary surgeon must constantly be on guard to act in a professional manner. The veterinary surgeon is a professional, not a salesperson.
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