Maintaining patient boundaries

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

  • Don't pursue a sexual or close emotional relationship with a patient or someone close to them.
  • 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.

Inappropriate relationships

The GMC's guidance in Maintaining a professional boundary between you and your patient (2013) says:

  • 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. Take into account the length of time since you treated them, the duration and nature of the professional relationship, the vulnerability of the patient (then and now) and whether you'll still be treating other members of their family. 

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 expensive gifts, flirtatious notes, texts or calls, invitations to meet socially and suggestive comments. 

Don't ignore inappropriate behaviour or accept gifts if you're concerned about the patient's motives. It could be taken as encouragement. 

Explain that you want the relationship to return to a professional level and that, if this is not possible, you may have to transfer their care to another doctor. Seek advice from the MDU if you are unsure about what to say or if the patient does not appear 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 remove them or in the event of a future complaint.  

Further action

Other measures to distance yourself professionally might include the use of a chaperone during consultations, although this would require the patient's consent. You could also transfer the patient's care to a practice colleague, but there is still a chance you might have to treat them in an emergency.

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 these steps to remove a patient.

Staying safe

Very rarely, a patient's behaviour may threaten your safety or that of others. In this situation, you should contact the police, ensuring 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. Seek advice from the MDU if you are unsure. 

You can remove a patient with immediate effect if they become violent or leave you fearing for your safety. To comply with your ethical and contractual obligations, you should follow these steps. 

Minimising the risks of social media 

The GMC warns that 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:

  • Do not accept friend requests from patients.
  • Do not 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 social media

Reporting sexualised behaviour by colleagues

The GMC's guidance, Sexual behaviour and your duty to report colleagues (2013), says you must raise concerns if a patient tells you about a breach of sexual boundaries or you believe a colleague has displayed sexual behaviour towards patients. This can include making inappropriate comments. You should also offer support to affected patients. 

If you suspect a doctor has committed a sexual assault or other criminal activity, you should make sure it is reported to the police.

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 quick guide to raising concerns for more information. 

 

This guidance was correct at publication 01/12/2017. It 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.

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