In June 2017 both the High Court and the Medical Practitioners Tribunal Service (MPTS) examined situations where doctors had engaged in sexual relationships with patients. In one case the doctor was erased and in the other the doctor received a written warning.
In ‘Good Medical Practice,’ the document containing the GMC’s ethical guidance, the regulatory body set out in Domain 4, Maintaining Trust, at paragraph 53: “You must not use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them.”
“You must not use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them.”
The GMC provide more detailed guidance in ‘Maintaining a professional boundary between you and your patient.’ In this document the GMC reminds doctors that trust should be the foundation of a partnership between a doctor and a patient; that patients should be able to trust that their doctor will behave professionally towards them and not see them as a potential sexual partner.
The GMC guidance at paragraph 4 states, “You must not pursue a sexual or improper emotional relationship with a current patient.” (My emphasis). Paragraph 8 of the guidance states that, personal relationships with former patients may also be inappropriate, depending on a variety of factors, including whether the patient was particularly vulnerable at the time of the professional relationship, and whether they are still vulnerable.
Strictly speaking, all patients are classed as ‘vulnerable’ when seeing a health practitioner, due to the imbalance in the relationship. However practically speaking, the vulnerability of a patient is usually assessed on a common-sense basis.
In the case of the doctor who was erased, he recently appealed to the High Court against his sanction of erasure. His appeal was dismissed on the basis that the Judge decided that the sanction of erasure was not excessive or disproportionate and therefore the erasure remains. This doctor was a GP, who formed a clandestine sexual relationship with a current patient, for approximately 8 months, who he was treating for mental health issues. She was regarded by the MPTS as being particularly vulnerable. The MPTS found that the doctor’s conduct was fundamentally incompatible with him remaining on the register, hence their decision to impose the sanction of erasure.
The second case involved a GP who met a woman socially, who was a patient, but not someone he had treated previously. They had an 8 month sexual relationship. During the relationship, he consulted with her regarding an implant and performed minor surgery on her, removing a skin lesion from her leg. The relationship ended amicably.
The patient refused to give evidence against the doctor, insisting that she was not vulnerable and that she had no concerns regarding the behaviour of the doctor.
In this case, there was no subterfuge and the issue was more about the doctor failing to ensure that he did not treat her once they had started to engage in a sexual relationship. This doctor demonstrated genuine insight into his mistake and in these circumstances the MPTS concluded that it was appropriate to give him a written warning.
The specific facts of a case are only a part of the decision-making process, and the doctor’s genuine insight into their misconduct is a significant factor for the MPTS when considering the most appropriate sanction. The doctor’s ability to also demonstrate remorse and remediation and therefore persuade the MPTS that there is no risk of repetition, will also play an important role in the final outcome.
These two cases demonstrate that the GMC will always take allegations relating to sexual relationships between a doctor and a patient seriously. However, the individual circumstances will be explored in detail, to come to a proportionate outcome in each given case. These two cases when explored in detail were very different and arguably both outcomes were appropriate and proportional to the specific circumstances prevalent in each case.