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Allegations of Sexual
Abuse |
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In a column 18 months ago, I
highlighted the risks of doctors entering into sexual relationships with
patients.1 I noted that complaints about doctors (and other health
professionals) overstepping professional boundaries and entering into
personal relationships with patients fall into a difficult area of HDC's
work. Fortunately, such complaints make up a tiny proportion of the 1000 or
so complaints received each year. Unfortunately, they are a recurring feature
and distressing for all involved. When a doctor enters into a sexual relationship
with a patient, he or she clearly oversteps appropriate boundaries. However,
as highlighted in a recent case, it is not just sex with patients that can be
a risky business. Boundaries can be blurred by other actions and lead to
concern and complaints irrespective of whether the relationship becomes
sexualised. Case study: simple gift start of
slippery slope The case in question involved a small town GP, Dr B, who was
consulted by Ms A in relation to a breast infection. During that consultation
Ms A told Dr B about her personal circumstances and her recent marriage
break-up. After a second consultation with Dr B, and some chit-chat about the
fact Dr B had recently started smoking again and could not smoke at the
surgery, Ms A invited him to her house (near the surgery) for a cup of coffee
and a cigarette. After a coffee and cigarette, Dr B left with a container
full of home-grown tomatoes from Ms A. Accepting a one-off gift of home-grown
produce may not in itself give rise to any ethical issues; however, it is
generally unwise and in this case it was the start of a slippery slope. Some
days later, Ms A's request for the return of the container led to a further
visit from Dr B. He claimed Ms A professed her attraction to him. Dr B said
he discussed with Ms A the inappropriateness of such comments but she broke
down and told him more about her relationship problems. Feeling uncomfortable, Dr B left,
but not before giving Ms A a hug "out of sympathy and concern". Ms
A's recollection of events was markedly different. She described Dr B
grabbing her and trying to kiss her while she endeavoured to repel his
advances. Whichever version of events one accepts, there were clear warning
signs the appropriate doctor/patient boundary was becoming blurred. It certainly
seemed irresponsible for Dr B to return to Ms A's house that evening with a
bottle of wine, irrespective of whose idea the bottle of wine was (which was
disputed). Ms A recalled letting loose and telling Dr B how inappropriate his
actions had been, in response to which he talked about his love life and said
that he wanted to be her lover. He then tried to kiss her again when walking
out to his car. In contrast, Dr B said he invited himself over to talk about
what had happened that afternoon, and that he was concerned about Ms A. He
raised concerns about what had transpired that afternoon and emphasised their
relationship could only ever be that of doctor and patient. Ms A then tried
to kiss him as he left. Complaint/investigation Ms A
subsequently complained to the medical centre where Dr B worked, and then to
my office. HDC takes complaints about inappropriate relationships with
patients very seriously, and commenced an investigation. Regardless of the
differing accounts, I considered Dr B "was naive and foolish in going to
the home of a patient in such circumstances, and it was most unwise to return
that evening with a bottle of wine". The matter was brought to the
attention of the Medical Council and the RNZCGP. Although the investigation
was discontinued in light of the markedly different accounts and lack of
corroborating evidence, it was undoubtedly distressing and stressful for Ms A
and Dr B. The distress could have been avoided had Dr B maintained
appropriate professional boundaries in his relationship with Ms A. Even
accepting Dr B's version of events, it is not difficult to see how his
actions sent mixed messages to a patient who he knew was going through a
stressful marriage break-up. Consoling hugs, home visits and bottles of wine
go well beyond the scope of an appropriate doctor/patient relationship. Dr B
may have been well-intentioned, but he was Ms A's doctor, not her friend.
Zero tolerance The Medical Council has for some time maintained a strict
"zero tolerance" position in relation to any breaches of sexual
boundaries. Its publication Sexual boundaries in the doctor/patient
relationship (March 2004) provides a thorough discussion of the issue and
practical advice for doctors on dealing with awkward situations. The council
makes it very clear it is the responsibility of the doctor, as the
professional, to set and maintain the professional boundary and respond
appropriately to any suggestion the boundary is threatened. One example of a
"danger sign" is giving or accepting social invitations from a
patient. Boundary issues, by their very nature, involve two people. However,
the onus is on the doctor to behave in a professional manner. As the Medical
Council notes, "It is not acceptable to blame the patient for your
transgressions." This is not to say doctors can
have no social contact with their patients. Such a prohibition would be harsh
and unrealistic - particularly in the context of a small town or rural
practice. Provided that professionalism and
commonsense guide a doctor in his or her interactions with patients, both in
and out of the surgery, there should be little room for concern. False accusations? Some doctors,
particularly male doctors, worry about being the subject of spurious claims
of a sexual nature. Once again, practical steps, such as the presence of a
"chaperone" (eg, a practice nurse), ensuring appropriate disrobing
facilities and clear communication are all useful ways for maintaining safety
for patients and doctors. Doctors who act professionally have little to fear
from false complaints. Vexatious complaints are very rare, and the
legislation empowers HDC to take no action if satisfied the complaint is not
made in good faith. As illustrated by this recent case, maintaining
professional boundaries requires more than just refraining from a sexual
relationship. Blurring of boundaries and failing to respond appropriately to
"danger signs" can be damaging for patients and stressful for both
parties, and risks professional censure and loss of credibility for the
doctor. (Ref 1) Ref 1. "Sex with patients - risky business", New
Zealand Doctor, 25 August 2004
(http://www.hdc.org.nz/publications.php?publication=225) |
