This ethical hub topic shows ways in which our ethical guidance can be applied in this area of care and signposts to relevant resources. It does not set new professional standards and is not intended to replace the formal guidance.
Sexual misconduct in healthcare is always unacceptable. It can have a devastating impact on individuals, teams and patient safety.
This page gives advice on how to identify and tackle sexual misconduct and make sure appropriate boundaries between doctors, patients and colleagues are maintained. It includes signposts to help and support anyone affected by sexual misconduct in the workplace.
- Be aware of how your behaviour may influence patients and other professionals within and outside the team.
- Treat colleagues fairly and with respect.
- Familiarise yourself with local policies addressing different aspects of sexual misconduct.
- Take a firm and consistent stand on issues of sexual misconduct to protect patients, maintain the public’s confidence in the medical profession and uphold standards of medical practice.
- Help and support is available for anyone affected by sexual misconduct in the workplace.
What is sexual misconduct?
Sexual misconduct is uninvited or unwelcome behaviour that can be reasonably interpreted as sexual – that offends, embarrasses, humiliates, intimidates or otherwise harms an individual or group. It encompasses elements of harassment and abuse and can be physical, verbal or visual. It can be perpetrated within and across different genders.
The scale of the challenge
A 2019 report for the Professional Standards Authority looking at fitness to practise cases brought against doctors, nurses and midwives, and allied professionals found that of 275 cases that included sexual misconduct as a charge, 232 related to sexual harassment or sexual abuse.
- The majority (88%) of perpetrators were male and were most commonly GPs, surgeons or staff working in mental health roles.
- The predominant target groups were patients and colleagues at 59% and 32%, respectively.
- Victims were typically vulnerable patients (49%), including young or infirm people and those with mental health illnesses.
The Truth Project Thematic Report on child sexual abuse in healthcare contexts between the 1960s–2000s found that of 4,295 people who shared an experience, 109 described abuse that took place in a healthcare context.
Given the power that doctors can hold and the fears that patients and colleagues might have, there may be underreporting of sexual misconduct by doctors.
Why are clear sexual boundaries important?
A breach of sexual boundaries can cause serious psychological, emotional or physical harm long after the abuse is perpetrated.
Patients have a right to be treated with dignity and respect and receive healthcare without fear of abuse.
Sexual misconduct damages and undermines the trust that patients have in their doctors and that the community has in the profession.
Sexual involvement with a patient impairs your judgement and influences decisions about the best possible care and treatment that is in the patient’s best interests.
For healthcare professionals
All healthcare professionals have a right to a workplace free of discrimination, bullying and sexual harassment.
A culture of civility and respect benefits staff wellbeing, enabling health professionals to work more effectively – ultimately improving patient safety.
Clear boundaries in healthcare settings
Be alert to warning signs that could indicate that boundaries are being or are about to be crossed. Early recognition and action can prevent harm.
Open, clear communication between doctors and patients avoids misunderstandings and helps maintain boundaries. See ‘Trust, communication and the power balance’ in the Sexual boundaries in the doctor-patient relationship tab for more information.
Listen to patients and colleagues, take account of their views, and respect their preferences.
Help and support to speak up
Help and support are available for anyone affected by sexual misconduct in the workplace.
Raising concerns about a colleague
Our ethical hub pages on Speaking up provide advice and tools to help you, as well as a list of organisations who can support you.
- Rape Crisis England and Wales, Rape Crisis Northern Ireland and Rape Crisis Scotland provide free, confidential emotional support, information and signposting by phone or email.
- NHS advice on help after rape and assault provides advice on what to do, the services that can help and how to support people.
- Rights of Women Sexual harassment at work advice helpline provides free and confidential legal advice to women and girls.
- SurvivorsUK operate a free, confidential national online helpline for men and boys.
- GALOP offer a free, confidential and independent helpline and support service for all LGBT+ people who have experienced sexual assault, violence or abuse.
- Sexual misconduct is a serious abuse of trust in the doctor-patient relationship and a failure of your duty of care to the patient.
- It is your responsibility to be aware of the imbalance in power and to maintain clear boundaries within the doctor-patient relationship.
- Personal relationships with former patients may also be inappropriate if this breaches the trust the patient placed in the doctor.
Trust, communication and the power balance
Trust is the foundation of the doctor-patient partnership. Sexual misconduct is a serious abuse of this trust and a failure of your duty of care to the patient.
Patients should trust that their doctor will behave professionally towards them during consultations. This enables patients to feel confident and safe, discuss personal information with you and allow you to perform physical examinations.
Open and clear communication avoids misunderstandings and helps maintain boundaries in the doctor-patient relationship. Good medical practice includes:
- Listening to patients, taking account of their views, and responding honestly to their questions, concerns and preferences.
- Giving patients the information they want or need regarding all aspects of their clinical management in a way they can understand.
- Gaining valid informed consent or other authority before you carry out any examination, investigation or provide treatment.
The power imbalance
An imbalance of power is inherent in the doctor-patient relationship, as the doctor has access to knowledge and resources that the patient needs, whether seeking assistance, guidance or treatment.
A power imbalance exists because:
- patients share personal and private information and allow physical examination and procedures to be diagnosed and treated. They may require examinations considered intimate – usually examination of the breasts, genitalia and rectum – and obstetric and gynaecological procedures, but could also include any examination or procedure where it is necessary to touch or even be close to the patient
- as the doctor, you advise on the level of intimacy and physical contact required to provide care
- as the doctor, you know what constitutes appropriate professional practice, whereas, for the patient, it might not always be clear whether a procedure is being conducted appropriately or if it is violating the standard of care.
Maintaining a professional boundary
As the doctor, it is your responsibility to be aware of the imbalance in power and maintain clear boundaries within the doctor-patient relationship.
Recognising that boundaries are threatened
Be alert to warning signs that could indicate that boundaries are being or are about to be crossed. Early recognition and action can prevent harm to both you and your patient.
Warning signs include:
- revealing to the patient, intimate details of your life
- providing a patient with your personal contact information without clinical justification
- preferring a certain patient to have the last appointment of the day without clinical justification
- seeing a patient at an unusual time or place without clinical justification and when other staff are not present
- social invitations
- giving and receiving gifts
- patients making inappropriate personal or sexual comments or displaying sexualised behaviour.
Intimate examinations and chaperones
In our guidance, Intimate examinations and chaperones, we highlight some of the issues involved in carrying out intimate examinations. You must follow this guidance and make detailed, accurate records at the time of the examination or as soon as possible afterwards.
Social media and other digital communication
Social media can blur the boundaries between a doctor’s personal and professional lives and may change the nature of the relationship between a doctor and a patient. Principles outlined in Good medical practice apply to social media and other digital communication tools such as email and text messages, as well as in-person consultations. You must also follow our guidance on Doctors’ use of social media.
Ending your professional relationship with a patient
If a patient pursues a sexual or improper emotional relationship with you, you should treat them politely and considerately and try to re-establish a professional boundary. If trust has broken down, for example, the patient has made a sexual advance towards you, you must follow the guidance in Ending your professional relationship with a patient.
Personal relationships with former patients may also be inappropriate if this breaches the trust the patient placed in the doctor. Doctors should recognise their influence on the patient and that the power imbalance may continue long after the professional relationship has ended.
However, as each doctor-patient relationship is unique, it is difficult to have clear rules on when it is or is not acceptable for a doctor to have a relationship with a former patient. In our guidance, Maintaining a professional boundary between you and your patient we set out what doctors should consider if they wish to pursue a relationship with a former patient.
Patients’ family members
A sexual relationship between a doctor and an individual close to a patient may impair judgement and undermine the patient’s healthcare.
Your duty to notify
4. If a patient tells you about a breach of sexual boundaries, or you have other reasons to believe that a colleague has, or may have, displayed sexual behaviour towards a patient, you must promptly report your concerns to a person or organisation able to investigate the allegation. If you suspect a doctor has committed a sexual assault or other criminal activity, you should make sure it is reported to the police.
5. You must offer support to any of your patients affected by a colleague’s breach of sexual boundaries.
6. You should respect patient confidentiality when reporting your concerns. But, the safety of patients must come first at all times. If you are satisfied that it is necessary to identify the patient, you should explain to the patient why disclosure is necessary. You should seek the patient’s consent to disclose information, unless it is not appropriate or practical to do so. If consent to disclosure is refused, but you judge disclosure is in the public interest, you must tell the patient of your intention to disclose the information. In all cases, you should only disclose relevant information.
Put your learning into practice...
- You must treat colleagues fairly and with respect.
- Make sure the culture of the teams you are part of is safe for colleagues and patients.
- If left unchallenged, instances of sexual misconduct can also lead to victimisation, bullying, and exclusion of the victim from the team in which they work.
- Consensual and reciprocated sexual attraction and relationships between colleagues are not sexual misconduct but can still create workplace issues.
Sexual boundaries between colleagues
Doctors must treat colleagues fairly and with respect and be aware of how their behaviour may influence others within and outside the team.
Consensual and reciprocated sexual attraction and relationships between colleagues are not sexual misconduct.
It is important that professional boundaries are maintained in the workplace. And the relationship – or end of the relationship – has no adverse impact on clinical practice or team environments.
Risk factors for inappropriate consensual relationships between colleagues include situations with significant differences in power levels between colleagues. Or situations where training and career progression opportunities could be affected.
Sexual misconduct between colleagues
All sexual misconduct in a workplace is inappropriate and can affect individuals, teams and patient safety.
These behaviours include:
- sexual comments or jokes
- displaying sexually graphic pictures, posters or photos
- suggestive looks, staring or leering
- propositions and sexual advances
- making promises in return for sexual favours
- sexual gestures
- intrusive questions about a person’s private or sex life or a person discussing their own sex life
- sexual posts or contact on social media
- spreading sexual rumours about a person
- sending sexually explicit emails or text messages
- unwelcome touching, hugging, massaging or kissing.
Instances of sexual misconduct are seldom isolated – perpetrators often offend repeatedly, and some abuse can last several years. If left unchallenged, such behaviour can also lead to victimisation, bullying, and exclusion of the victim from the team in which they work.
It can also escalate to further physical and sexual violence, including rape. This will have a negative and devasting impact on individuals, team cultures and patient safety. The sooner an intervention takes place, the greater the likelihood of stopping the misconduct.
Sexual misconduct within doctor-student interactions
Given the specific power imbalance between doctors and students in higher education, notions of ‘wanted’ behaviour and consent are complex.
By using their position of power to blur the boundaries between professional and personal relationships to gain control over and sexual access to students, doctors can perpetrate sexualised and predatory behaviours towards students. This can include sexual coercion and promising resources, for example, career advancement and access to training in return for sexual access.
It is the responsibility of the doctor to maintain professional conduct in their dealings with students.
Your duty to notify
Doctors have a critical role in identifying and managing sexual misconduct and ensuring that they have taken reasonable steps to protect patients, the public and their colleagues.
The severity and nature of the misconduct in individual cases will determine the responses that you might take. You should familiarise yourself with local policies addressing different aspects of sexual misconduct and use your judgment in making a decision.
25c. If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or us. If you are still concerned, you must report this in line with our guidance and your workplace policy, and make a record of the steps you have taken.
59. You should challenge colleagues if their behaviour does not comply with this guidance, and follow the guidance in paragraph 25c if the behaviour amounts to abuse or denial of a patient’s or colleague’s rights.