Maintaining patient boundaries

How to manage inappropriate patient behaviour and avoid blurring the lines with patient relationships.

  • Act quickly to re-establish boundaries if a patient behaves inappropriately.
  • Avoid sharing personal information with patients in person or online.
  • Report sexualised behaviour towards patients by colleagues.
  • Don't pursue a sexual or close emotional relationship with a patient or someone close to them.

Inappropriate relationships

The GMC's 'Maintaining a professional boundary between you and your patient' (2024) guidance includes the following points.

  • You must not pursue a sexual or improper emotional relationship with a current patient.
  • You must not use your professional relationship with a patient to pursue a relationship with someone close to them.
  • Think carefully about the ethics of having a relationship with a former patient. Consider the length of time since you treated them, the nature of the professional relationship, the vulnerability of the patient (then and now), whether you'll still be treating other members of their family and whether you could be seen to be abusing your professional position.

How to manage inappropriate patient behaviour

Be alert to signs that the doctor-patient professional boundary is becoming blurred for a patient. This might include gifts, flirtatious notes, texts or calls, invitations to meet socially and suggestive comments. Try not to ignore inappropriate behaviour. It could be taken as encouragement.

Explain that you want the relationship to return to a professional level and, if this is not possible, that you may have to transfer their care to another doctor. Seek advice from the MDU if you're unsure about what to say or if the patient doesn't seem to have heeded your request.

Keep a record of the conversation and follow it up in writing, as well as a log of all contact from the patient. This could be helpful if you were ever asked to justify your decision to end your professional relationship with them, or in the event of a future complaint.

Further action

Other measures to distance yourself professionally might include using a chaperone during consultations, although this would require the patient's consent. You could also transfer the patient's care to a suitable colleague, but there's still a chance you might have to treat them in an emergency (if you're part of the same GP practice, for example).

If the patient continues to behave inappropriately, seek our advice on how to proceed. If it becomes necessary to end your professional relationship with the patient, you should follow the GMC guidance. If it becomes necessary to deregister the patient from your GP practice list, be aware of your contractual obligations and follow these steps.

Read our guide on maintaining professional relationships with patients for more advice.

Staying safe

Very rarely, a patient's behaviour may threaten your safety or that of others. In this situation, you should contact the police, making sure you obtain an incident number. However, you should not disclose confidential clinical information about the patient without their consent, unless this can be justified in the public interest. Again, seek advice from the MDU if you are unsure.

You can deregister a patient with immediate effect from your GP practice list if they become violent or threatening to such an extent that you have had to call the police. To comply with your ethical and contractual obligations, you should follow these steps.

Minimising the risks of social media

Social media can blur professional boundaries and change the nature of the doctor-patient relationship. Here are some practical steps you can take to guard against this:

  • don't accept friend requests from patients
  • don't discuss medical care and treatment with patients via social media
  • avoid sharing sensitive personal information online
  • regularly review the privacy settings for each of your social media profiles.

For more information, take a look at our guide to using social media.

Reporting sexualised behaviour by colleagues

The GMC's 'Maintaining personal and professional boundaries' (2024) guidance says you must raise concerns if a patient tells you about a breach of sexual boundaries or you believe a colleague has, or may have, displayed sexual behaviour towards patients. Sexual behaviour does not necessarily involve touching (GMC, paragraph 23). You should also offer support to affected patients.

If you suspect a doctor has committed a sexual assault or other criminal activity, you must report this in line with your workplace policy, or to a person who is in a position to take action.

When reporting concerns you should respect patient confidentiality and, if necessary, seek the patient's consent to disclose relevant information. If consent is withheld, you can make a disclosure if it is in the public interest but you must inform the patient.

See our guide to raising concerns for more information.

This page was correct at publication on 30/01/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.