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Flirtatious patient

Tempting though it may sometimes be to respond to the flirtatious patient, do beware, warns

Dr Melanie Wynne Jones

One of the pleasures of general practice is establishing a rapport with your patients. But as with any relationship, you may sometimes find yourself wondering whether a line has been crossed.

Research suggests that people respond more positively to attractive individuals, and we may find ourselves doing exactly that.

Or we may feel flattered by patients' apparent admiration. We may also feel that a little harmless banter brightens up the consultation for all concerned. But it's important to be aware of ourselves, of the patient and of the potential pitfalls of an inappropriate relationship.

Some men and women habitually employ eye contact, flattery, over-familiarity and uninvited touching in their interactions with other people. This may give us an insight into their personality. But it can also make us uneasy in the consulting room.

Patients like these can usually be discouraged by our using a detached professional approach. But if this doesn't work, breaking eye contact, deliberate use of body language, and ignoring cues will show that you do not wish to engage.

More disconcerting is the patient of either sex whose flirtatiousness seems deliberately aimed at one individual ­ you.

Or the patient who gives you the uncomfortable feeling that something could be going on, but you can't be quite sure about this ­ and you certainly don't want to ask!

It may be what they say, the way they say it, or the fact that they seem to be consulting excessively. You may be surprised by a request for an apparently unnecessary examination, or by provocative clothing (although this seems to be the norm for many people nowadays!).

What are the possibilities?

·You have completely misread the situation

·This is the patient's normal way of behaving (see above), and not particularly significant

·The patient is deliberately trying to manipulate you for material gain (sicknotes, prescriptions)

·The patient is actually attracted to you (knowingly or not); you may even feel attracted in return

·Transference is operating (a psychotherapeutic phenomenon in which patients transfer their feelings for a particular person on to the therapist)

·You risk becoming the victim of

de Clerambault's syndrome, also known as erotomania, in which the patient (more commonly a woman) holds the delusional belief that someone else, usually of a higher social or professional status, is in love with him or her ­ this is a dangerous form of stalking, and fortunately very rare.

Clearly, there are hazards for both patient and doctor.

A routinely professional air should help to prevent misunderstandings. Some patients may become our friends; but we still need certain boundaries, especially when it comes to divulging personal information that could be interpreted as inviting intimacy.

Following GMC advice, offering or even insisting on a chaperone for examinations that require the removal of clothing, and resisting compliments linked to demands to be endlessly available, are also important.

Document inappropriate comments/actions if necessary; a videotaped consultation can also be illuminating.

If you start to hear alarm bells, it's time to share concerns and to seek advice, from your trainer or another member of your practice, however embarrassed you feel. You may discover that your worries are actually groundless. You may also find that your admirer routinely but harmlessly targets GPRs!

But if your worries are confirmed, then you must disentangle yourself. Simply 'dropping' the patient could be seen as harmful and unethical. It could even trigger a complaint, although staff may be able to steer the patient towards appointments with another doctor.

You may need to seek advice from your medical defence society, and there are also implications for the practice, including bad publicity or possible removal from the list.

If you act early enough, it is unlikely that there will be serious repercussions. However, this is a significant event. You will need to reflect on how the situation arose, so that you can spot the warning signs in future.

What the GMC says

Good Medical Practice

20 You must not allow your personal relationships to undermine the trust which patients place in you. In particular, you must not use your professional position to establish or pursue a sexual or improper emotional relationship with a patient or someone close to them.

24 Rarely, there may be circumstances ­ for example where a patient has persistently acted inconsiderately or unreasonably ­ in which the trust between you and the patient has been broken and you find it necessary to end a professional relationship with a patient. In such circumstances, you must be satisfied your decision is fair... you must be prepared to justify your decision if called on to do so.

Intimate examinations

·Keep discussion relevant and avoid unnecessary personal comments.

·Give the patient privacy to undress and dress and use drapes to maintain the patient's dignity. Do not assist the patient in removing clothing unless you have clarified with them that your assistance is required.

Melanie Wynne-Jones is a GP in Marple, Cheshire

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