Dr Beverley Ward
When the boundaries of the doctor-patient relationship are breached, it's important to know how to respond.
Earlier this year, Dr Eleanor Aston backed a campaign launched by her two local MPs calling for the maximum sentence for stalking offences to be increased from five to ten years. Dr Aston, a GP, had been continuously stalked and harassed by a former patient for seven years.
While that sort of extreme scenario is thankfully rare, it's not uncommon for patients to want more than a professional relationship with their doctor. The MDU has helped around 100 members over the last five years with advice on how to deal with patients making amorous advances. A handful of these involved the type of stalking behaviour where a doctor may need to involve the police.
But with doctors more accessible than ever via social media, amorous approaches from patients can feel intrusive. If they are not nipped in the bud, or even unwittingly encouraged, things can get out of hand.
Amorous advances by patients can include receiving unwanted letters and gifts and, more commonly now, text or social media messages. In more extreme cases, patients have turned up at a doctor's work or home. This has the potential to develop into stalking and harassment, with some patients creating a fantasy affair to which the doctor is completely oblivious.
Some patients can be very distressed if they feel their advances are being ignored or rejected, and their behaviour can become aggressive or vindictive. The MDU has seen cases of doctors referred to the GMC by patients alleging a fabricated sexual relationship, or even complaints to the police of sexual assault.
Stalking and harassment
Harassment became a criminal offence in 1997 with the introduction of the Protection from Harassment Act 1997, and stalking became a specific offence when this was amended by the Protection of Freedoms Act 2012. The government is proposing a 'Stalking Protection Order' aimed at protecting victims of stalking by strangers, who are not protected in the same way as victims of stalking by ex-partners. If introduced, this could offer some welcome protection for doctors who are the victim of stalking.
It's important to maintain professional boundaries in your relationships with patients. If you have reason to believe that a patient wants a personal relationship with you, tell them as soon as possible that your relationship with them must remain on a professional footing. Make it clear to them that their behavior is inappropriate and must stop.
If that fails and your professional relationship with the patient has broken down, you may need to transfer the care of the patient to a colleague. You should explain the reason to the patient, and it's also important to keep a log of all contacts and to get support from your colleagues and the MDU.
The MDU's advice on dealing with amorous patients also includes:
- contact the MDU for advice as soon as you become aware of a potential difficulty with a patient
- ensure you inform your line manager of the situation
- keep a log of all inappropriate contacts from the patient
- if you continue to care for the patient, it is advisable to use a chaperone for all consultations
- accepting gifts from patients can be misconstrued, so consider very carefully whether it may be better to politely refuse a gift
- don't use personal email addresses or mobile numbers for work purposes, review your social media privacy settings, and withhold your number if you have to use a personal phone to contact a patient
- consider reporting the patient to the police if you feel threatened or in danger.
The following anonymised example shows the type of scenario which can develop.
Doctor stalked by patient on social media
A GP saw a patient in the practice about a knee injury, and shortly afterwards he delivered a box of chocolates and a thank you card to the practice, addressed to her.
He had included his address and telephone number in the card but at this stage the GP was not concerned, and the chocolates were shared among the practice staff.
Shortly afterwards, the GP received a Facebook message from the patient asking why she hadn't contacted him, as he had strong feelings for her and would like to meet for a drink. The GP ignored the message and told her colleagues so that all future appointments would be booked with her male colleagues.
The patient wrote to her at the practice, saying he loved her and wanted to meet outside the practice. The next day he sent her multiple messages via social media, insisting that she respond to him. The GP contacted the MDU for advice at this point, as she was frightened by the intensity of his contacts.
The MDU adviser agreed that the GP should not respond directly, or see the patient in consultation. If the doctor had to see the patient in an emergency, it would be best to have a chaperone present.
The MDU adviser also suggested that the practice manager or senior partner write to the patient, making it clear that his behaviour was inappropriate and causing distress, and that it must stop. The letter should explain what would happen if he tried to contact the GP again, such as removal from the practice list or police involvement.
The GP was advised to keep copies of all contacts from the patient, as well as ensuring her social media security settings were at an appropriate level.
Unfortunately, even after the warning letter was sent, the patient's behaviour escalated. He came to the surgery in person, demanding to see the GP and becoming very aggressive when this was refused. He was asked to leave and was seen waiting at the surgery car park entrance. The GP was concerned for her safety and reported the matter to the police.
The police warned the patient that further contact would result in a charge under the Protection from Harassment Act 1997. The patient was also removed from the practice list, and there was no further contact from him.
Dr Beverley Ward
Beverley is a former GP and has been a medico-legal adviser at the MDU since 2008. She provides advice and assistance to members of all specialties on ethical and legal matters arising from their care of patients.
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