04 • Boundaries
AN IMPROPER R T
Is it ever appropriate to become romantically involved with a patient – past or present? Dr Susan Gibson-Smith offers some advice
RUST is the foundation of the doctor-patient partnership. There is a clear public interest in patients being assured their doctor will behave professionally towards them. While this is a familiar concept for doctors in relation to issues of confidentiality, it is also vital patients can trust doctors will behave professionally during consultations and will not view
them as potential sexual partners.
Consider the following scenario: It was a girls’ night out to celebrate our exam success and the end of GP training. After a meal and drinks we headed to the local nightclub – and that’s where I met Mark. We got on well and afterwards he said he would find me on Facebook. I thought no more about it until he appeared in my surgery two weeks later with a knee injury from football. I took a history, examined him and gave him the appropriate advice
on rest, ice and elevation and he asked if that meant no more dancing. I said “yes” and he asked if I would have dinner with him instead. I was flustered. I liked him and if he had asked me in the club I would have said yes… but now we had met in the surgery, what was I to do? The General Medical Council offers guidance on this area in Good
Medical Practice, as well as its supplementary guidance Maintaining a professional boundary between you and your patient, and Sexual behaviour and your duty to report colleagues.
The message to doctors is clear: “You must not use your professional
position to pursue a sexual or improper emotional relationship with a patient or someone close to them.” It would be improper, for example, to arrange regular reviews of a
child purely to develop a relationship with the parent, or to make a home visit to an elderly man in order to see more of his son. The word “must” is used by the GMC to emphasise an overriding duty and any failure to follow this will result in a doctor’s registration being put at risk.
Unwanted attention It can be difficult when a patient makes unwanted advances and MDDUS has received calls from doctors who have been given letters or gifts or invitations by patients whose motives are not quite clear. It is always good practice to respond politely and considerately and to try to re- establish the professional boundary, explaining it is not appropriate for a doctor to have that type of relationship with a patient. Seeking help from a neutral person such as the practice manager or senior partner can also be useful. For extra clarity, it may be appropriate to write a letter of response to
the patient (with help from MDDUS) gently pointing out that this type of behaviour is not acceptable. In extreme cases, where a doctor feels that trust has completely broken down, then a decision can be taken to end the doctor-patient relationship and remove the patient from your list. If
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