A GP registrar rang the MDU for advice after he met a woman he wanted to invite out on a date.
This is not normally not the sort of thing that would present a medico-legal dilemma, but in this case the woman in question was the niece of a patient he was treating for COPD, and whom he had met on a home visit. The GP wondered whether it was acceptable to go out with the niece because, while she had been a patient of the practice, she had recently moved out of the area and was no longer on the practice’s books.
Some recent evidence suggests that younger doctors might have a different perspective on relationships with patients when compared with conventional professional attitudes.
Researchers writing in the Journal of Medical Ethics questioned 62 medical students on four occasions during the course of their training asking for reactions to a number of different ethical situations. One involved a doctor on a small Scottish island who was invited to dinner by a patient. The students were told that at the end of a professional visit ‘the patient smiles and warmly invites you for dinner, clearly evidencing an interest in being more than your patient’.
The majority said they would politely refuse the invite on grounds that it would be unprofessional, unethical or compromise the doctor–patient relationship — but 40 per cent said they would accept the invitation.
Some of this group justified their answer by saying it would be difficult to meet a partner in such an area, while others said they could keep private and professional lives separate. Some simply said ‘doctors are only human’.
The recently updated version of the GMC’s Good Medical Practice deals with the issue of whether it is ever permissible for doctors to have relationships with former patients. The guidance makes it clear that, in order to maintain public trust and a professional boundary, a doctor must not use their professional position to establish or pursue a sexual or improper emotional relationship with a patient or someone close to them (see paragraph 32 of Good Medical Practice).
Published last year, Maintaining Boundaries provides additional GMC guidance and gives a detailed explanation of the principles set out in Good Medical Practice. It acknowledges that situations sometimes arise in which doctors may wish to consider a sexual relationship with a former patient, and says that in such circumstances doctors must ‘use their professional judgment and give careful consideration to the nature and circumstances of the relationship’.
Doctors should take account of the nature of the previous professional relationship, when it ended and 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 guidance sets out various circumstances in which it would not be appropriate to pursue a sexual or emotional relationship with a former patient, and states that doctors must ‘not use home visits to pursue a relationship with a member of the patient’s family’.
It states: ‘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 lack of maturity’.
The guidance makes it clear that pursuing a relationship with a former patient may be inappropriate regardless of the time elapsed since the therapeutic relationship ended. This is because it is difficult to be certain that the professional relationship is not being abused in some way.
Which brings us back to the GP registrar. The MDU advised that he carefully consider and apply the GMC’s advice and use his own judgment to decide whether it was an appropriate relationship to pursue. It is important to avoid any action that could be misconstrued as taking advantage of a doctor’s position of trust and responsibility, or as exploiting vulnerable individuals.
Much would depend on the nature of the prior professional relationship, and on the doctor and patient concerned — but the MDU adviser warned that where even a slight uncertainty existed in the doctor’s mind as to whether a relationship would be ethically appropriate, it would be safest not to pursue it.
Dr Devlin is a medico-legal adviser with the MDU
How to avoid inappropriate relationships in the surgery
- 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 where, at the time of the professional relationship, the patient was vulnerable.
- Where social contact with a former patient leads to the possibility of a sexual relationship, you must use your professional judgment and give careful consideration when the professional relationship ended, its nature, how long it lasted, whether the patient was vulnerable at the time and whether you will be caring for other members of the patient’s family.