Shaun Howe explores the dangers and repercussions of forming relationships with patients
We work in a very intimate way with our patients; the relationship of trust that we have to build in a very short space of time (especially with patients new to us) is quite a difficult one to form. While there is, in the patient’s mind, some expectation of the invasion of their space that does not mean that we can be perceived to abuse that trust in anyway.
We have all met patients that we felt could have made our lives complete and have known or do know people who have gone on to form longlasting and meaningful relationships with (former) patients. This is a very human trait and normal but in these days of heavy regulation it is something that may compromise our professional standing or indeed get us in to trouble with the regulators.
The Council for Healthcare Regulatory Excellence (CHRE) was formed in 2004 and is the overarching body that looks at all the healthcare regulators, including the GDC. Following several high-profile cases, most notably at the General Medical Council, this organisation issued guidance (2008) to all the regulators with which it is concerned on how their fitness to practise committees should deal with registrants who have been implicated in unsuitable relationships with patients .
Keep it legal
If you or any of your colleagues decide they must have a relationship with a patient, then I would urge you to read the advice in the references listed and heed it. Transfer the care of the patient so that there can never be any accusations of the type listed and seek the advice of perhaps a more experienced colleague.
They published, in early 2008, a document titled, ‘Clear Sexual Boundaries between Healthcare Professionals and Patients2’ that defined how the healthcare professional could be perceived as abusing this trusting relationship. To support this, the CHRE has issued patient information that is really quite clear in what it states that patients can expect with regards to the relationships between patients, their carers and healthcare professionals.3
All the wrong moves?
Invasion of space is
acceptable
Abuse of patient trust is unacceptable
Single or not, you cannot have a relationship with a patient
We hold the balance of power over our patients. Any digression may be perceived as an abuse of that power
It is irrelevant whether we are single or that the patient is single, the fact remains that the regulators have deemed it inappropriate for healthcare professionals to have relationships with patients regardless of circumstance.
The guidance at reference 2 does give some advice on what to do about what are very human emotions, and also outlines how we should act if we form relationships with former patients. The CHRE in its guidance, discuss how we as healthcare professionals, hold the balance of power over our patients and that any digression out of the normal relationship that we have could be perceived as an abuse of that power.
Falling foul
It is easy to see how we could easily fall foul of our regulator. Dr X, began the two-year relationship with the builder, known only as Patient A, a year after meeting him at her surgery, the GDC heard. The man’s wife, Mrs A, later learned of the affair, which ended 2008, during a late-night call from Dr X on Valentine’s Day 2009. The panel accepted Dr X’s claims the relationship had fizzled out by the end of the year, despite records showing she called his mobile 143 times and sent him 1,892 texts. Dr X confessed to her infidelity to her husband. She admitted callingPatient A’s wife in the early hours, but was cleared of ‘spitefully’ revealing the affair to Mrs A.
Issuing a formal reprimand, the GDC panel chair said Dr X’s affair had ‘crossed professional boundaries’. He said: ‘The committee determined that sexual relations between dentists and their patients might be viewed by the public with disapproval.’
He added that Dr X’s initial denial of the affair was ‘intentionally misleading and dishonest’. The chair said: ‘This was deplorable behaviour and necessarily misconduct.’
I am sure many of us can envisage situations as we read the above case. This was a very real case at the GDC – and the complaint was made by the patient’s wife. But the same really does apply to all our patients.
References
1. http://www.gcc-uk.org/files/page_file/Guidance_for_Fitness_to_Practise_PanelsJan08.pdf
2. http://www.gcc-uk.org/files/page_file/Responsibilities_of_Healthcare_Professionals_Jan08.pdf
3. http://www.chre.org.uk/_img/pics/library/pdf_1286381124.pdf
Shaun Howe trained in the Army in 1993. He joined the real world in 1999 and currently works in two practices full time in Nottingham and Derbyshire. Shaun started speaking in 2005 and has spoken nationally to various groups.
