Dear Alice,

I am a graduate student here at Columbia and have been using the Health Service for a number of years. On recent visits, I couldn't help but notice a certain nurse practitioner on whom I now have a big crush (pardon the school-kid terminology). On my last visit through walk-in, luck would have it that I got this person to treat me (a random happening--I didn't choose it in any way). I felt somewhat awkward during the visit, yet happy to see this person. Nonetheless, I realize that this is not an ideal state of affairs, but I don't know how to handle it. I am due to return to this same N.P. for follow-up.

Should I tell this person that I feel awkward receiving medical treatment from someone I would rather be dating, or should I just make an appointment with another person? Would it be possible to seek medical attention from this person after letting them know how I feel? If I do end my medical relationship with this person, how would I begin a different one? There don't seem to be many occasions when students and the Health Service staff interact outside a medical setting. I would hate to pass up the possibility of meeting that someone special due to professional constraints that would not hold had we met under different circumstances.

—Confused but hopeful

Dear Confused but hopeful,

To crush on a person in a position of authority or trust is so common, it seems almost inevitable. Many people have at least one experience in their life of crushing on their teacher, physician, nurse, therapist, veterinarian, or other professional healer or helper. Many more people have fantasies and role—play scenarios that involve hooking up with their doctor, older neighbor, baby–sitter, or other "inappropriate" powerful figure. There is something erotic about power imbalance for many people that likely has something to do with the vulnerability inherent for the "patient" in these relationships, as well as the forbidden nature of crossing such boundaries. This is not to say that the power differential between you two is the sole cause of your crush, but it may be one contributing factor.

And here is where acting on these feelings in real life gets tricky. Many schools have policies that prohibit relationships between staff and students if there is an established professional relationship or if there has been one in the past (meaning the staff member does not or has not supervised, evaluated, advised, mentored or had involvement in any employment actions with the student in question). Exceptions to this policy occur at the authorization of the Vice President of Human Resources. Additionally, telling your NP about your attraction could place her or him in a bit of a predicament. If s/he reciprocates your feelings, s/he may still be obligated to maintain professional boundaries based on a specific professional code of ethics, the rules of her or his office or supervisor, and her or his own personal ethics code. Even if you both agree to terminate the medical relationship, your NP's job or credibility could be on the line if they acted on feelings for you.

It may be worth exploring the pros and cons for you personally of disclosing your feelings. Additionally, it may help to try anticipating the possible outcomes of telling the person, and how you might feel or respond in which each case.

What do you see as possible pros of disclosure? Perhaps relief at putting the feelings out there; getting more clarity about the possibility of dating the person; not having to wonder what might have been, and others? And what may be potential cons? Feeling awkward; possibly facing rejection; making your NP uncomfortable? Make a list of both the pros and cons if it feels useful.

What are the possible outcomes?

  • Your NP reciprocates the feeling, but says s/he cannot get involved because of the boundaries or professional policies
  • Your NP reciprocates the feeling, but says s/h cannot get involved because of some other reason, such as being in a pre-existing relationship 
  • Your NP does not reciprocate and you feel guilty, sad, uncomfortable, or some other unpleasant emotions 
  • Your NP does not reciprocate, but it is not awkward and you do not feel badly 
  • Your NP reciprocates and it works out to terminate the medical relationship and start dating 
  • Others?

What outcomes can you live with? Do any of these feel particularly difficult to handle? Does disclosing feel worth the risk of whatever you view as the worst possible outcome? How urgent is the desire to make your attraction known? Will you feel regret if you do not? Will you feel regret if you do, and it doesn't go as hoped?

Getting really familiar with your thoughts and feelings about the outcomes, the positives, and the drawbacks, as well as potential consequences for the NP, will be your ticket to the answer about the best course of action.

Good luck!


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