It has always been essential for doctors to maintain professional boundaries and not establish or pursue any sexual, exploitative or other inappropriate relationship with someone under their care. Such relationships are always unethical and usually harmful to patients and the wider community because of issues surrounding power imbalance, trust, safety and quality of health care.
However, the new guidelines (Guidelines) discuss the various types and spectrum of behaviours that can constitute breaches of sexual boundaries and place a doctor’s registration at risk. The Guidelines will be used by the Board in determining what constitutes appropriate professional conduct.
Examples of breaches of professional boundaries
The Guidelines indicate that there is “no place for sex in the doctor-patient relationship” and identify the following behaviours as breaches or likely breaches:
- engaging, or trying to engage, in a sexual relationship (regardless of patient consent) with a current patient, former patient or individual close to a patient (e.g. carer or guardian);
- conducting a physical examination that it not clinically indicated or not consented;
- asking a patient to undress more than is necessary or failing to provide a privacy screen/cover;
- certain behaviours including making sexual remarks, gestures or innuendos, flirtatious behavior or inappropriate touching;
- seeking sexual history or preference information when it is not clinically relevant;
- using the power imbalance to abuse or exploit the patient’s trust or vulnerability for sexual purposes;
- any unwelcome sexual behavior likely to offend, humiliate or intimidate a reasonable patient; and
- sexual assault.
If a doctor recognizes any inappropriate feelings or behaviours either from themselves or the patient, the doctor should try to re-establish boundaries and seek advice or transfer care to another practitioner.
Regarding relationships with former patients, the general rule is that they should be avoided. However, the Board will consider numerous factors including:
- the duration, frequency and type of care provided by the doctor;
- the degree of vulnerability of the patient;
- the extent of the patient’s dependence in the doctor-patient relationship;
- the time elapsed since the professional relationship ended;
- the manner and reasons why the professional relationship ended or was terminated; and
- the context in which the sexual relationship started.
Observers or Chaperones
The Guidelines indicate that a doctor may wish to have a qualified observer or chaperone present during an intimate examination of a patient, or in a consultation generally. A patient has the right to refuse an observer, and in that case the doctor may (a) proceed without an observer or (b) find another doctor to perform the examination
Doctors must maintain their professional boundaries both offline and online. In the event that a patient attempts to engage with a doctor through social medial (or other digital communication) about non-professional matters, then the doctor should politely decline and direct them to their usual means of communication.
The Guidelines can be accessed here.