Unwanted advances

MDDUS advisers sometimes assist members 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 indirectly, 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 and dentists will also use dating apps, 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.

A recent case

In one recent MDDUS case, a GP 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 her messages until she finally had no option but to block his number. A few weeks later the GP was surprised to see his name appear on her appointment list for that day. She hoped it was coincidental that the patient shared the same name as her date but was understandably anxious about the encounter.

It transpired that it was the same individual. The GP managed to retain her professionalism and asked if he preferred to rebook with another GP or if he was happy to continue (which he was). She explained to the patient that it would be better to book with a different clinician at the practice the next time. After the consultation, she contacted MDDUS and was advised that she had acted correctly. Speaking with other staff she discovered that he was registered with the practice and there was no ulterior motive in his making the appointment; the consultation was purely coincidental.

Regulatory advice

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."

GDC Standards (9.1.4) are also specific: "You must maintain appropriate boundaries in the relationships you have with patients. You must not take advantage of your position as a dental professional in your relationships with patients.”

Relationships with former patients

The GMC states explicitly that doctors must not pursue a sexual or improper emotional relationship 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”.

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 or dentists pursue a relationship with 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 GP 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.
• Maintain privacy settings on social media to prevent unwanted friend requests or private messages.
• Take a polite but direct approach to unwanted advances by reiterating that you wish the relationship to remain purely professional.
• Speak with a colleague/trainer 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 and dentists must maintain appropriate boundaries in the relationships they have with patients.
• Follow regulatory guidance for maintaining professionalism when a patient makes an unwanted advance.
• Maintain privacy settings on your personal social media pages to avoid unwanted attention from patients.
• Seek advice before considering a non-professional relationship with a former patient.

Kay Louise Grant is risk adviser at MDDUS