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doctors are warned against sex with former patients
- joyce Edeki (31 October 2006)
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Warning against having sex with former patients is not enough
- Wolfgang Spiegel, Tanja Colella, Philip Lupton (31 October 2006)
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Doctors should not take advantage of people
- Charles O Olojugba (3 November 2006)
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Relationships with former patients
- Helen L Roberts (4 November 2006)
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joyce Edeki, locum consultant psychiatrist learning Disability, 41 old dover road, canterbury, Kent. CT1 3HH
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I believe it is long overdue that the GMC have clearly stated policies on this issue. However, personal responsibility is fundamental. Whilst not condoning doctors who have sex with their patients, I just want to state some permutations. Primarily doctors are humans, and having a consensual sexual relationship with a former patient should not be so frowned at. Especially if such 'sex' is within the context of a genuine relationship. However a doctor who takes undue advantage of a patient and engages in sex should be so disciplined. It is cruel and very unethical to betray patients trust! One would immediately question the credibility of such a doctor. Trust is the fundamental bond between a patient and a doctor. No doctor should be allowed to break such trust in such a manner whatever the circumstances. Every doctor needs to be able to exercise self control and good judgement in their sexual preferences and choices. All humans have a right to make choices but the moment you decide to become a doctor a far greater sense of responsibility to operate with self control becomes even more obvious and crucial. The specialty of a doctor is equally important, while it would be frowned at if a psychiatrist has such nature of relationship with a former patient, an anaesthetist may not be. As doctors,we have worked so very hard to attain this position of trust in the society.It is a noble profession and rightly so the envy of many, why then would anyone allow the benefit of a momentary pleasure of sex rob you of such 'status'. Yes one may argue that many doctors may have personality issues just like any other person in the population, but the difference is that, as a doctor, the training and priviledges one is opportuned to have is not comparable. In accordance with the wise saying, "To whom much is given much is expected" having said that, a doctor may be a former patient, and as such a relationship can exist between the doctor and such patient and could potentially lead on to marriage. being a former patient does not in any way make one any less worthy of a relationship with a doctor. It is random and indiscriminate sex with patients (whether current or former) that should be avoided and penalised in every way to deter others. Humans have a right to make choices even sexual, which may either seem sensible or senseless; the one clear advantage that we as humans have above other animals is the ability to exercise self control and good judgement. I believe that GMC can make so many warnings but that could never replace personal responsibility and accountability. Competing interests: None declared |
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Wolfgang Spiegel, Research Fellow Department of General Practice, Center for Public Health, Medical University of Vienna, Tanja Colella, Philip Lupton
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Sir, Lynn Eaton brought to our attention the GMCs' guidance on sexual relations with former patients (www.gmc-uk.org/guidance). To warn students and doctors against sex with former patients is a honorable thing to do but does it suffice? I think it does not because students and doctors need to be shown how to handle sexual feelings in the physician-patient relationship. They should be shown how to reflect on feelings of personal affinity with a patient, so as to identify restricting factors and possible consequences. We have ourself published recommendations for teachers on how to best address the issue in an educational intervention (Spiegel W, Colella T, Lupton P. Sexual feelings in the physician patient relationship: recommendations for teachers. Medical Education 2003; 37:840-841). There is a need that medical curricula help students to examine what role sexuality plays in the physician-patient relationship and to analyze its interpersonal dynamics, including its intimate nature. Five arguments have been put forward for a "zero tolerance policy" with regard to sexual contacts resulting from the physician-patient relationship. We have ourself argued against this arguments for zero tolerance (Spiegel W, Colella T, Lupton P. Private or intimate relations between doctor and patient: is zero tolerance warranted? Journal of Medical Ethics 2005; 31: 27-28). The history of prohibition is a long one and rarely has to report successes in cases where attitudes or behaviours were supposed to be enforceable. We look forward to a social climate where the doctor, when experiencing a feeling of personal affinity with a patient, is encouraged to reflect on it so as to identify restricting factors and possible consequences. Competing interests: None declared |
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Charles O Olojugba, Specialist registrar St pancras Hospital; London NW1 OPE
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The new guidance by the GMC on the issue of sexual relationships with former patients is in my view based on the principle that doctors should not take advantage of people. I agree that this should be true if we are to continue to be trusted by our patients who are the public. The breaking down of boundaries in the new doctor patient relationship does mean that the chances of feelings of intimacy developing between doctor and patient are higher than before. Though this guidance could be seen as interference with peoples rights to date whom they choose as long as they are not current patients (after all there are examples of doctors whom are currently happily married to previous patients ) i think that the wider interests of the profession as a whole and the possibility of loosing our right to self regulation are factors that make this guidance necessary. The belief that the power differential between doctors and previous patients is such that equity is not possible and the doctor must be taking advantage in some way can be described as patronizing to patients by some but as with any guidance the position of the GMC on this issue is welcomed by myself and will be protective of doctors and patients alike. Competing interests: None declared |
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Helen L Roberts, Children's Mental Health Nurse and trainee counsellor Epping Forest
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I took part in the online consultation that the General Medical Council (GMC) undertook in the summer 2006. Having now read the recently published supplementary guidance I feel that the GMC have managed to accurately reflect within the guidance the views of the majority of those who posted responses on the website. I beleive that it was an immensely difficult task which required the GMC ethics team to consider many aspects and variables of a possible doctor/former patient relationship. The crux of the matter being to ensure that vulnerable former patients (such as those who suffer from mental health problems) are protected while at the same time enabling genuine mutual relationships between consenting competent adults (no longer professionally involved)to evolve naturally and without feelings of guilt and anxiety. In my opinion it would have been extremely detrimental to the emotional wellbeing of doctors and former patients if the GMC had produced a one size fits all ruling, banning all relationships with all former patients. As was pointed out by many of those who posted responses on the GMC consultation website, there are numerous examples of happy and healthy relationships between doctors and former patients and it would quite simply be a violation of human rights to rule against this. Existentially speaking the doctor should be encouraged and enabled by the GMC to consider the situation for him/herself and to justify his/her choices and actions accordingly. I feel that the GMC are quite right in asking the doctor to carefully consider the specific factors, if social contact with a former patient leads to the possibility of a relationship developing. In particular I was heartened that the GMC ask the doctor to consider the vulnerability of the former patient. The GMC make reference to past vulnerability, when the former patient was under the doctors care. However they also ask the doctor to consider whether or not the former patient is still vulnerable at the time that the doctor is considering embarking on a personal relationship with them. I feel that it is of paramount importance that current vulnerability should be part of the doctors decision making process. I believe that it would be unethical to assume that because a patient was once vulnerable while they were in the position of being the patient, that they will be vulnerable for ever more. Further more, I beleive that it would be morally wrong to assume that a doctor would abuse a former patient whom he/she met socially at a later date, just because the former patient had been vulnerable at the time that they were the patient. From a philanthropic point of view vulnerabilty is a human condition that frequently goes hand in hand with many illness's or traumatic events, mental or physical. Measuring someones vulnerability is a subjective process and differences of opinion would leave a doctor open to critiscm if the GMC had not written the guidance in such a way that enables the doctor to feel supported to make his/her own ethical decision. This issue may have great personal relevance to many doctors such as GP's who would undoudtedly be able to find one or more episode of vulnerability in most patient's medical histories. It would inhumane to place a doctor at risk of accusations of professional misconduct for falling in love with such a patient. I personally beleive that there is much misconception in society about mental health problems. Common mental health problems such as depression and anxiety will affect most of us at some point in our lives and that includes doctors and other health care professionals alike. It does not automatically follow that because a person has suffered from a mental health problem that they are forever vulnerable or unable to make their own competent choice with regards to dating a doctor who treated them in the past. In fact I would argue that it requires great personal strength and insight to recover and move on from a serious episode of an illness such as depression. Competing interests: None declared |
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