Hugs from patients raise personal boundary dilemma

After a member faced an awkward encounter, we advise on whether it is okay to hug or be hugged by a patient.

A GP member contacted us for advice on an awkward situation he had faced the previous week. As a patient had been leaving his room she had embraced him in a hug. The context was that the patient had been through a difficult time and was grateful for the care the GP had provided. The doctor had been taken by surprise and wondered if he should have done anything differently.

Colleagues opinions' varied on the incident with some saying they do hug patients if it feels appropriate and others saying that they would always refuse to hug a patient, even if the patient initiated it. The GP asked the MDU if there was any medico-legal guidance on giving or receiving a hug from a patient.

Weigh up the situation

While the GMC is clear that doctors must not use their 'professional position to pursue a sexual or improper relationship with a patient or someone close to them', there is no guidance from the regulator specifically on hugging.

Doctors must be able to comfort and show human compassion to their patients, but will need to weigh up the situation before them and decide whether physical contact could be misconstrued. This is an area that is potentially fraught with problems as it can be tricky to determine if physical contact is appropriate.

Bear in mind that a hug you initiated can be misunderstood, particularly if coupled with other words or actions the patient may feel are inappropriate. This can trigger a complaint or even lead to police and GMC involvement. Another scenario to be avoided is if a patient initiates a hug because they have amorous feelings towards you.

While in many cases offering or accepting a hug from a patient may not mean that you have crossed a professional boundary, how do you walk the seemingly fine line between being human and being labelled inappropriately familiar?

A hug in context

It will often come down to the context for the hug and the individual patient's preferences. There are plenty of people who can be visibly upset but prefer not to be physically comforted, even by close friends, so it's important to make a judgement based on the situation and your knowledge of the patient.

Other factors, such as the gender and age of the doctor and the patient, also need to be weighed up when agreeing to be hugged by or offering to comfort a patient.

In the situation where a patient initiates a hug which you are not comfortable with it can be difficult to know what to do, especially if the patient is upset. However, just because you are a member of a caring profession, this doesn't mean you are obliged to give and receive unwelcome hugs.

Usually, offering a patient your hand and a smile instead along with an explanation that you feel that hugging oversteps a professional boundary is the kindest method of shutting down an attempted hug. In this way you make it clear that it is nothing personal while offering an alternative, which may reduce any embarrassment. On the other hand, if you are happy to be hugged by a distressed or grateful patient, then you don't necessarily need to rebuke an advance.

Make a note

It is always advisable to document your consultation with the patient fully, including any physical interaction, as it may help with the patient's ongoing care and in case it is later reported as being inappropriate. You could include mention of the circumstances surrounding the hug, who initiated it, and any verbal consent given by the patient.

While giving or receiving a hug may be a genuine human reaction to seeing another person in distress, erring on the side of caution can prevent inadvertent or unintentional misunderstandings and the medico-legal processes that may ensue.

Contact the MDU for further advice on maintaining boundaries with patients.

This guidance was correct at publication 12/02/2018. 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.

Dr Ellie Mein MDU medico-legal adviser

by Dr Ellie Mein Medico-legal adviser

MB ChB MRCOphth GDL LLM

Ellie joined the MDU as a medico-legal adviser in 2013. Prior to this she worked as an ophthalmologist before completing her Graduate Diploma in Law in Birmingham.

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