The GMC’s publication ‘Good Medical Practice’ makes clear that doctors should not use their professional position to establish or pursue a sexual or improper emotional relationship with a patient. Last month, the GMC issued supplementary guidance called ‘Maintaining Boundaries’ which provides a detailed explanation of these principles. For example, it advises that doctors must not use a home visit as an excuse to pursue a relationship with a member of the patient’s family.
Relationships with ex-patients
Most doctors are aware that having a personal relationship with a patient would undermine the doctor–patient relationship. However, GPs sometimes ask the Medical Defence Union (MDU) about relationships with ex-patients. The guidance gives advice on this area for the first time. It sets out what GPs need to consider if they are thinking of pursuing such a relationship.
The GMC advises: ‘You must not pursue a sexual relationship with a former patient, where at the time of the professional relationship the patient was vulnerable, for example because of mental health problems, or because of their lack of maturity.’
The guidance adds that the pursuit of a relationship with a former patient may be inappropriate regardless of the time elapsed since the therapeutic relationship ended.
However, the GMC acknowledges that situations sometimes arise in which doctors may wish to consider a sexual relationship with a former patient. In such circumstances it says that doctors must ‘use their professional judgment and give careful consideration to the nature and circumstances of the relationship’. GPs should take account of the nature of the previous professional relationship, when it ended and for how long it lasted, whether the patient was vulnerable at the time (or still is vulnerable) and whether they will still be caring for other members of the patient’s family.
The MDU advises doctors thinking about starting a relationship with a former patient to apply the GMC’s advice and use their own judgment to decide whether it is appropriate to pursue it. Much will depend on the nature of the prior professional relationship and on the doctor and patient concerned. For example, it might be perfectly appropriate for an A&E doctor who saw a patient for 20 minutes to stitch a wound and who, by coincidence, ran into the same person socially a couple of years later to start a relationship with that former patient.
On the other hand, a GP who meets a former patient who has moved out of the practice area, whom he or she has previously treated for depression and anxiety, may find it difficult to justify pursuing a sexual relationship.
‘Maintaining Boundaries’ also gives updated advice on intimate examinations and chaperons. The GMC advises that chaperons do not have to be medically qualified although, ideally, they should be familiar with the examination being performed and should be able to reassure the patient. In some circumstances, a member of practice staff or a relative or friend of the patient may be acceptable. The guidance recommends offering to delay the examination until a chaperon is available.
If you are not sure what to do, the GMC advises discussing your concerns on a confidential basis with an impartial colleague, medical defence organisation, professional organisation or the GMC itself.
Dr James is a medico-legal adviser with the MDU
Follow the rules
- You must not pursue a sexual or improper relationship with a patient.
- You must not use a patient as a pretext to form a relationship with someone close to them.
- You must not pursue a sexual or emotional relationship with a former patient if the patient was vulnerable at the time of the professional relationship.
- If social contact with a former patient leads to the possibility of a sexual relationship, you must use your professional judgment.
- Factors you need to consider are: when a professional relationship ended and how long it lasted; the nature of the previous professional relationship; whether the patient was particularly vulnerable at the time of the professional relationship; whether they are still vulnerable; and whether you will be caring for other members of the patient’s family.
- Always offer a chaperon when carrying out an intimate examination. Be aware that some patients may consider routine touching or even being close to them (such as performing ophthalmoscopy in a darkened room) as an intimate act and thus requiring a chaperon.
- A chaperon does not necessarily have to be medically qualified and, if appropriate in the circumstances, may be a member of practice staff or a relative or friend of the patient.