Sexual Boundaries in Doctor Patient Relationship

Question 1

Why breaching sexual boundaries is unethical and harmful

Answer 1

• Exploitation of Power Imbalance
• Exploitation of trust that examinations and treatments will only be undertaken in their best interests.
• Safety - Patient may suffer emotional and physical harm.
• Quality - Doctor likely to lose independence and objectivity to provide good quality healthcare.
• Public confidence - Community will be deterred from seeking medical care.

Question 2

Spectrum of behaviours that breach sexual boundaries

Answer 2

• Unnecessary comments about patient’s body or clothing
• Conducting a physical examination that is not clinically indicated or when the patient has not consented to it.
• Behaviours of a sexual nature - Sexual remarks including humour or innuendo
• Asking patient about sexual history or preferences when these are not relevant to their healthcare.
• Sexual harassment
• Sexual assault

Question 3

Board factors in reviewing whether relationship with former patient is unethical or unprofessional.

Answer 3

• Long duration, frequency and long-term emotional or psychological treatment
• Degree of vulnerability of the patient
• Time elapsed since the end of the professional relationship.
• The manner in which, and reason why, the professional relationship ended or was terminated.
• The context in which the sexual relationship started.

Question 4

Good medical practice when conducting physical examination

Answer 4

• Being aware of verbal or non-verbal signs the patient has withdrawn consent.
• Not continuing with an examination when consent has been refused or withdrawn
• Providing suitable covering for examination so that patient is covered as much as possible.
• Using gloves when examining genitals or conducting internal examinations.
• Consider chaperone
  
  • If refused by patient and if you feel uneasy regarding consult. Can refuse to examine and try to organise another doctor.