Doctors should think carefully before becoming sexually involved with a former patient, the General Medical Council warns in its updated guidance on acceptable professional practice.
Until now relationships with former patients have not been explicitly proscribed. But supplementary guidance on maintaining boundaries—published alongside the latest guidance on appropriate professional behaviour—says that pursuing a sexual relationship with any former patient will “usually be inappropriate, regardless of the length of time since the therapeutic relationship ended.”
The warning comes because “good medical practice” encourages doctors to work in partnership with patients, fostering relationships that are based on openness, trust, and good communications.
The GMC’s president, Graeme Catto, acknowledged that this new closer working relationship could have the “undesirable” consequence that doctor and patient became inappropriately close as traditional professional boundaries are broken down.
“A relationship between a doctor and a patient is never really equal,” Sir Graeme said. “It isn’t a blanket ban. The issue is in the vulnerable patient. It is good for the doctor to be clear the patient is no longer vulnerable [before embarking on the relationship].” He admitted that this is a difficult tightrope to walk, although he defended the council’s decision to introduce the measure.
The guidance says that doctors must not pursue a sexual relationship with a former patient who was vulnerable at the time of the professional relationship, such as someone with mental health problems or who lacked maturity. The GMC says that this is because it may be difficult to be certain that the professional relationship is not being abused.
If doctors are not sure whether they could be seen to be abusing their professional position they should discuss the situation with an impartial colleague, a medical defence body, a medical association, or a member of the GMC’s standards and ethics team, the guidance adds.
But the main change in the new guidance, the first version of which was published in 1995 and which updates the 2001 version, is the need to take account of patients’ views in assessing their condition and to support them in self care. Where a patient opts for treatments other than that recommended by the doctor, that decision has to be accepted, said Sir Graeme. “If a patient decides not to take medical advice, that is their prerogative. Doctors need to learn that the patient’s wishes come first. Partnership is not an optional extra. It is an absolutely integral part of our guidance. The age of deference has gone,” he said.
The guidance also says that doctors should play a role in promoting public health, encouraging patients to take an interest in their health and to take action to improve and maintain it. It adds that doctors should not refuse or delay treatment because they believe a patient’s actions have contributed to their decision.
Other new recommendations include guidance on non-discrimination, equality, and diversity and on doctors’ duty to report to the GMC any convictions against them anywhere in the world or findings against them by any professional body. The supplementary guidance on conflicts of interest states that where a contributor to an educational meeting has been sponsored by a drug company this should be announced at the meeting.
Good Medical Practice is available at www.gmc-uk.org/guidance.