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They should document these discussions as well as the contacts they have had with the patient, and they should keep a log of all messages the patient has sent, including emails and text messages.It may be necessary to transfer the patient’s care to someone else in the team, and doctors should seek advice from their defence organisation.Professional boundaries are an essential part of the doctor-patient relationship, but they are sometimes crossed by both doctors and patients.In 2013-14 the General Medical Council (GMC) investigated 93 complaints against 90 doctors who were alleged to have had an inappropriate relationship or made inappropriate advances towards a patient.The GMC’s guidance goes on to say that doctors “must not end a professional relationship with a patient solely to pursue a personal relationship with them.” Personal relationships with former patients may also be inappropriate, depending on a number of factors, such as whether the doctor will be caring for other members of the patient’s family.GMC guidance does not specify a length of time after which it would be acceptable to begin a relationship with a former patient.A more challenging example is the patient who behaves in an obviously seductive manner and may declare their feelings for the doctor.
A boundary violation, such as a sexual relationship with a patient, is defined as always being harmful or having the potential to cause harm. This is because boundary violations can compromise the quality of patient care and undermine both the trust of the patient in their doctor and the trust of the public in the medical profession.GMC advice to doctors whose patient has pursued a sexual or improper emotional relationship is that they “should treat them politely and considerately and try to re-establish a professional boundary.” The GMC acknowledges that it may be necessary to end the professional relationship if trust has broken down.These measures may not be effective for all patients, and a small number of patients will continue to pursue the doctor in the hope of a relationship, perhaps even believing that the doctor reciprocates their feelings.The types of patients who pursue their doctor range from those with inappropriate feelings that may be secondary to loneliness and poor relationships, to those who are delusional and may have an underlying psychiatric illness. The response to an advance from a patient should be appropriate and proportionate to their actions.Some patients express their feelings by using non-verbal communication—for example, by giving inappropriate gifts or cards.