Inappropriate sexual behaviour in colleagues

A SEARCH on the GMC website will offer up numerous examples of doctors who have fallen foul of the regulator by pursuing affairs with patients and often on practice or hospital premises. This despite the clear stricture in Good Medical Practice that as a doctor "you must not use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them".

Such affairs rarely stay secret for long and often become the subject of rumour and speculation among staff and colleagues. There may be tell-tale signs – excessive phone calls from one particular patient or late and overlong consultations.

In one recent case a GP in Suffolk admitted to an affair with a female patient that began with an exchange of text messages and turned physical during treatment for a painful shoulder. It was only after the affair had been discovered that the GP admitted all to the practice business manager who then called a meeting of the partners. The partners decided to report the matter to the local PCT and to the GMC.

This was a wise decision considering some GMC guidance that was recently made explicit in a document published in March. Sexual behaviour and your duty to report colleagues was among a raft of explanatory guidance published along with an updated version of Good Medical Practice.

In the guidance the GMC states: "If a patient tells you about a breach of sexual boundaries, or you have other reasons to believe that a colleague has, or may have, displayed sexual behaviour towards a patient, you must promptly report your concerns to a person or organisation able to investigate the allegation. If you suspect a doctor has committed a sexual assault or other criminal activity, you should make sure it is reported to the police."

The guidance further clarifies that by the term "colleague" it means anyone a doctor works with, whether or not they are also doctors. It also states that a doctor must support any patient affected by a "colleague’s breach of sexual boundaries".

In complying with this guidance any question of professional loyalty must be overridden. GMC guidance on Raising and acting on concerns about patient safety states that: "If you are hesitating about reporting a concern for these reasons, you should bear the following in mind. You have a duty to put patients’ interests first and act to protect them, which overrides personal and professional loyalties."

Furthermore, absolute proof is not necessary in reporting concerns as long as it is done so honestly and based on "reasonable belief" and through appropriate channels. The GMC advises that if the concern is about a GP partner it may be appropriate to raise it outside the practice to a medical director or clinical governance lead. Doctors in training might consider contacting a postgraduate dean or director of postgraduate general practice education. In any case you should make a clear record of your concerns and the steps taken to deal with them.

Similar principles will also likely apply for dentists. The GDC states that dental care professionals should maintain appropriate boundaries in relationships with patients and there is a responsibility to raise any concern that patients might be at risk.

Patient confidentiality is another important consideration in such cases. GMC guidance states: "You should respect patient confidentiality when reporting your concerns. But, the safety of patients must come first at all times. If you are satisfied that it is necessary to identify the patient, you should seek the patient’s consent to disclose information, explaining why the disclosure is necessary. If consent to disclosure is refused but you judge disclosure is in the public interest, you must tell the patient of your intention to disclose the information. In all cases, you should only disclose relevant information."

If you are in doubt over any of these matters or their specific application contact MDDUS for further guidance.

ACTION: Promptly report to an appropriate authority any concerns you may have over the sexual conduct of a colleague towards a patient.