Professional boundaries

Personal profit and/or incentives, financial or otherwise, should not affect your professional judgement. This includes referring patients and prescribing specific products.

The doctor−patient relationship is based on trust. The GMC’s Good Medical Practice section on professionalism says that good doctors are “honest and trustworthy, and act with integrity and within the law.”^[i]

Keeping relationships professional
In its ‘GMC Thresholds’ (2021) document, which outlines the types of cases where the GMC is likely to take action, the GMC explicitly states that cases of “sexual or improper emotional relationships with a patient or someone close to them”^[ii] are likely to have some implications on a doctor’s registration.

The nature of medical practice means that, in some instances, patients can become emotionally dependent on their doctors. There must be an awareness of this possibility in such situations – any doctor who takes advantage of this dependency is potentially abusing responsibility and trust, and leaving themselves open to allegations of misconduct, with the GMC adding: “the more vulnerable someone is, the more likely it is that having a relationship with them would be an abuse of power and your position as a doctor.^[iii]

Communicating with patients
Good communication between doctors and patients is fundamental to the delivery of safe and good quality patient care. This includes giving full and detailed information about all relevant aspects of a service, to ensure patients are able to make informed decisions about their healthcare.

The GMC also warns that “when advertising your services, you must make sure the information you publish is factual and can be checked, and does not exploit patients’ vulnerability or lack of medical knowledge.^[iv] It also outlines that you must not allow any interests you have to affect the way you prescribe for, treat, refer, or commission services for patients, regarding financial or commercial arrangements you may have.^[v]

Chaperones
The presence of a chaperone can be of reassurance to both patients and doctors, especially when there is a need for an intimate examination to be performed, regardless of the gender of either the doctor or the patient.^[vi]

GMC’s ethical guidance for doctors states: “A chaperone should usually be a health professional and you must be satisfied that the chaperone will:

• be sensitive and respect the patient’s dignity and confidentiality
• reassure the patient if they show signs of distress or discomfort
• be familiar with the procedures involved in a routine intimate examination
• stay for the whole examination and be able to see what the doctor is doing, if practical
• be prepared to raise concerns if they are concerned about the doctor’s behaviour or actions.

You should record any discussion about chaperones and the outcome in the patient’s medical record. If a chaperone is present, you should record that fact and make a note of their identity.”^[vii]

Social media
Expectations around doctors’ professionalism and maintaining boundaries with patients, safeguarding confidentiality, and showing respect for colleagues are the same when using social media.

Before posting online, consider the following safety checklist:

• Would I say this out loud to a group of patients/peers (or my grandmother)?
• Am I about to make an offensive comment about another person or colleague?
• Am I about to make a comment that could be perceived as prejudiced against a person’s race, sexuality, gender, religion, or other protected characteristic?
• Would what I am about to say damage the reputation of the medical profession?
  
  

For doctors, there is the additional risk of patients contacting you through social networking sites. In addition to allowing patients access to your personal details, these sites are generally inappropriate for medical discussions. It is important to retain professional boundaries and while you may not want to offend a patient by declining a friend request, it would be prudent to be very careful when considering these situations and to politely decline.^[viii]

Personal conduct
As a doctor you are required to always act with honesty and integrity, this means that “you must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.^[ix]

 

Further information

Professionalism in action - ethical guidance - GMC (gmc-uk.org)

Chaperones (medicalprotection.org)

Ask the expert – social media (medicalprotection.org)