Case study: The following fictional example, based on cases from the MDU's files, shows how much is at stake.
A patient visited her GP, complaining of shortness of breath. The GP asked her to remove her top so he could carry out a chest examination and check her BP. He did not offer a chaperone as there was no one immediately available.
Later that day, the patient contacted the police alleging that the GP had inappropriately touched her and made suggestive comments. The GP denied the allegations but was interviewed under caution where he was represented by an MDU solicitor. He then received a letter from the GMC to say it was investigating his fitness to practise and he was later suspended by an Interim Orders Panel. The story was picked up in the media and the GP was photographed and door-stepped by a journalist.
The CPS did not prosecute the GP after a relative of the patient came forward to say she had made similar allegations against other health professionals in the past. However, the stress of the investigation and press attention meant the doctor was not well enough to return to work for several months. As a result of his health problems, the GMC imposed undertakings that included reports from his own GP for a further 18 months.
Defining ethical boundaries
The GMC covers the subject of maintaining boundaries extensively in its new version of Good Medical Practice1 and in three new explanatory guidance documents: Intimate examinations and chaperones, Maintaining a professional boundary between you and your patient, and Sexual behaviour and your duty to report. The MDU advises you to pay particular attention to the following points.
Relationships with patients
The GMC is clear that it is never ethical to pursue an 'improper emotional relationship' with a patient or someone close to them, such as a family member. Nor should you ask a patient to see another GP so you can begin a relationship. If considering a relationship with an ex-patient, you are advised to consider factors such as the nature of the professional relationship and whether the patient was vulnerable, the time that has elapsed and whether you will be caring for other members of the family.
Occasionally your professional relationship with a patient may become blurred through no fault of your own, for example, if they try to befriend you on a social networking site or engineer meetings outside the surgery.
In this situation, it is best to gently but unambiguously ask the patient to stop, explaining that you need to maintain a purely professional relationship and anything more is impossible.
If they persist, keep a record and contact your medical defence organisation as soon as possible as it is important to respond appropriately and not inflame the situation.
We also advise you to be conscious of how social media can blur the boundaries between your professional and personal life and to avoid using inappropriate language on social networking sites.
Patients are at their most vulnerable when undergoing intimate examinations and this demands the highest standards of professionalism, including an explanation of what is involved in the examination, why you need to carry it out, and the offer of a chaperone which should be a healthcare professional.
You need to be sensitive to what examinations or procedures the patients themselves might consider intimate, such as eye or ear examinations where it is necessary to dim the lights.
You have a duty to act if you believe that a colleague has displayed sexual behaviour towards a patient. This does not necessarily involve touching the patient and could include making inappropriate sexual comments. Your medical defence organisation can advise you further on what steps to take in this situation.
Avoiding a relationship with a patient is just one aspect of maintaining boundaries with patients but it is important to always be mindful of other times when the professional and personal could become blurred, whether you are in your consulting room, in a social situation or even at your home computer.
- Dr Macaulay is a medico-legal adviser at the Medical Defence Union
1. Good Medical Practice, GMC, 2013