Unwanted advances

SOMETIMES doctors can be faced with the difficult situation of a patient making romantic advances.

The patient may mistake care and compassion for something other than professional support and seek a more personal relationship. Such advances may be made directly during a consultation or less directly, perhaps by dropping hints or by leaving ‘thank you’ gifts.

The increased use of social media has made this even more common, as patients can now find ways of messaging privately.

Some doctors may also use dating apps in their personal lives, where there is an increased risk of being approached by patients on a personal profile. You may not realise until a relationship progresses that someone you are in contact with could be a patient.

An example case

Consider the following scenario. A dermatologist member was matched and started engaging with a person on a popular dating app. They met for dinner one night and she enjoyed his company but declined an offer of a second date. He took the perceived rejection badly and continued to send the doctor messages until she finally had no option but to block his number. A few weeks later the doctor was surprised to see his name appear on her clinic list for that day. She hoped it was coincidental that the patient shared the same name but was understandably anxious about the encounter.

It transpired that it was the same individual. The doctor managed to maintain her professionalism and asked if he preferred to rebook with another doctor or if he was happy to continue (which he was). She explained to the patient that it would be better if he was seen by a different doctor the next time.

After the consultation, she contacted MDDUS and was advised that she had acted correctly, as this was in the patient’s best interest. Speaking with colleagues later, she discovered that the patient’s consultation was purely coincidental and that he had no control over which doctor he saw.

Regulatory guidance

GMC guidance on maintaining professional boundaries is very specific:

“You must not pursue a sexual or improper emotional relationship with a current patient… If a patient pursues a sexual or improper emotional relationship with you, you should treat them politely and considerately and try to re-establish a professional boundary. If trust has broken down and you find it necessary to end the professional relationship, you must follow the guidance in Ending your professional relationship with a patient."

The guidance is explicit on relationships with a current patient – but what about pursuing a relationship with a former patient? The advice here is that it depends on individual circumstances, including how long has passed since the doctor-patient relationship ended, how long the professional relationship lasted and the nature of the professional relationship.

The guidance states that “the more recently a professional relationship with a patient ended, the less likely it is that beginning a personal relationship with that patient would be appropriate”.

GMC guidance also states that doctors “must not end a professional relationship with a patient solely to pursue a personal relationship with them”.

Power imbalance

The Professional Standards Authority points out in its guidance: “Research shows that a patient may be harmed as a result of a sexual relationship with his or her former healthcare professional, however long ago the professional relationship ended. This is because the sexual relationship may be influenced by the previous professional relationship, which will often have involved an imbalance of power.”

So any relationship with a former patient is problematic and requires very careful consideration and advice. An overarching concern for regulatory bodies and the NHS is that under no circumstances should doctors pursue a relationship with a patient or former patient who could be considered vulnerable. Such action would be viewed as a clear abuse of trust and difficult to justify in any circumstance. It is perhaps stating the obvious, but a relationship between a psychiatrist and their former patient (involving long-term emotional or psychological support) may be viewed differently than a relationship between a doctor and a former patient consulted only briefly in relation to a purely physical health issue.

Avoiding difficulties

Members are best to avoid situations that could risk crossing professional boundaries. Practical measures include:

• Avoid having patients as friends or followers on social media apps.
• Ensure you are aware of and manage your privacy settings in a way you are comfortable with.
• Take a polite but direct approach to unwanted advances by reiterating that you wish the relationship to remain purely professional.

Speak with a colleague/educational supervisor and/or MDDUS if you are uncomfortable with a patient’s behaviour towards you. Sharing your concerns will demonstrate insight into the situation and should also help facilitate transferring that patient’s care to another clinician (if appropriate).

Key points

• Doctors must maintain appropriate boundaries in the relationships they have with patients.
• Follow regulatory guidance for maintaining professionalism when a patient makes an unwanted advance.
• Ensure you are aware of and manage your privacy settings.
• Be aware of your professional obligations and relevant guidance and consider seeking advice before considering a non-professional relationship with a former patient.

Kay Louise Grant is a risk adviser at MDDUS