GPs must never abuse their positions, but neither should we bar consensual relationships with patients, says Dr Tony Grewal
The GMC's Good Medical Practice guidance is clear: ‘Maintaining trust in the profession – 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.' A commonly held view is that sexual relationships with patients are completely taboo, but this guidance above is less absolute and merely prohibits using one's professional position to establish or pursue such a relationship.
No-one could condone exploitative or predatory behaviour, which rightly places
a doctor at very high risk of censure, but professional guidance is designed to protect patients, reassure the public and maintain confidence in the profession – it should not limit the capacity of consenting adults to explore a relationship. A succession of GMC determinations have established brief sexual encounters and more established relationships with patients may occur without need for GMC sanction, providing these have taken place without taking advantage of a professional position or a vulnerable patient.
When might a relationship be acceptable? When both parties are in ignorance of the professional position? Very few people will establish their GP practice on first acquaintance! When no social contact is possible other than with registered patients, for example where one practice covers an entire community? When a mutual attraction develops during the course of professional interaction, but is then tested outside of that?
An absolute ban on sexual relationships with patients or former patients is an unfair limitation on the right to pursue happiness for doctors and patients alike. The days are gone when a doctor's word was law; many of us would doubt we are even a profession any more. Do we still have to adhere to requirements which are a hangover from a bygone era? Most of us cannot suppress a cynical laugh when the sententious words of Lord Bingham are dragged out yet again to justify punitive action: ‘The reputation of the profession is more important than the fortunes of any individual member. Membership of a profession brings many benefits, but that is part of the price.' What benefits? And what a price!
Consumerism, empowerment of patients and intervention of politicians have reduced us to little more than skilled tradesmen. Do plumbers and their clients face similar sanctions if they enter a relationship? The assumption a sexual relationship between a doctor and a patient is automatically exploitative no longer holds, and is patronising to all involved. While many of us still have an instinctive reaction to relationships with patients almost akin to our feelings about incest, surely it is time these matters were for the individual's judgment and conscience.
The law has developed safeguards for victims of exploitative sexual partners – which apply to doctors. Additional limitations are no longer appropriate. We need new, authoritative public guidance which acknowledges the changes of the last 20 years, maintains necessary safeguards for the vulnerable, but gives a framework for those who wish to develop proper relationships.
The burden of proof must remain with the individuals concerned, consent must be valid and public safety and confidence maintained – but the idea that sex with patients is always professionally wrong must be consigned to the dustbin of history.
Dr Tony Grewal is a GP in Hillingdon, west London, and medical director of Londonwide LMCs. He is writing in a personal capacity
Relationships between GPs and patients will always be unequal and should be avoided, says Dr Surendra Kumar
One could argue two consenting adults are entitled to take decisions about their personal and sexual lives without it being the business of legal agencies or regulatory bodies like the GMC. But we have to take into account the circumstances those two consenting adults are in. One is a GP, a member of a highly respected profession, sitting on a pedestal with enormous powers. The other is vulnerable and perhaps unwell, a patient who might be willing to do virtually anything to get rid of their illness, and therefore to remove their vulnerability. Consider the powers of the doctor. This is the only profession of which a member can ask a person to take their clothes off and find the request usually met with few questions and no resistance.
A proper emotional and sexual relationship is a partnership of equals, both parties enjoying the same rights, privileges and limitations. Both have a right to agree or disagree with each other. Any other basis for a relationship is flawed and needs to be criticised and resisted most vehemently. It is vital proper boundaries are maintained in relationships between doctors and patients.
The GMC says in its Good Medical Practice guidance: ‘You must not use your professional position to establish or pursue a sexual or emotional relationship with a patient or someone close to them.' And: ‘You must treat patients with dignity.' It also says in its supplementary guidance issued in 2006: ‘Trust is a critical component in the doctor-patient partnership: patients must be able to trust doctors with their lives and health. In most successful doctor-patient relationships a professional boundary exists between doctor and patient. If this boundary is breached, this can undermine the patient's trust in their doctor, as well as the public's trust in the medical profession.'
It adds: ‘The doctor-patient relationship may involve an imbalance of power between the doctor and patient. This could arise, for example, from the doctor having access to expertise and healthcare resources that the patient needs, or the possible vulnerability – emotional or physical – of a patient seeking healthcare.'
There are some examples where successful relationships have been built between doctors and patients that have culminated in long and happy marriages. However, I would argue you should not and cannot conclude on the basis of those examples that a relationship built on the basis of flawed principles is going to be right for the majority.
Dr Surendra Kumar is a GP in Widnes, Cheshire, and chairs fitness to practice hearings for the GMC