Working with doctors Working for patients

 

...protect from risk of serious harm...

In the first scenario of the case study, Dr Gallagher suspects that Ms Cieslak may be a victim of domestic violence. The GMC's guidance on confidentiality allows for disclosure of confidential information in order to protect third parties from a risk of serious harm. As with any disclosure it is usually best to get the patient's consent (an important exception being if this could undermine the reason for disclosing the information), but disclosures without consent may be justified in some circumstances.

Although Ms Cieslak initially denies that there is a problem, Dr Gallagher persists with his questioning until she tells him about the abuse. Had she not, Dr Gallagher should have tried to establish whether there was anyone else who would be at risk, if his suspicions about domestic violence were correct - specifically whether there were any children who may be at risk. The GMC's core guidance booklet for doctors, Good Medical Practice gives them a duty to safeguard and protect the health and well-being of children, and a duty to offer assistance to children if they have reason to think that their rights have been abused or denied.

...any inducement gift or hospitality...

Good Medical Practice states that doctors must not 'ask for or accept - from patients, colleagues or others - any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients'. Even if a doctor is certain that a gift or hospitality will not affect his or her professional judgement, if it is other people's perception that it might do, then this could still have a negative impact by undermining those people's confidence in their own doctors, and public trust in the profession.

In the Dr Gallagher scenario, Ms Cieslak suggests that they go for a meal together. A situation like this might well result in a breach of the professional boundaries that should exist in a successful doctor/patient relationship.

...relationships with former patients...

Good Medical Practice states that doctors must not 'ask for or accept - from patients, colleagues or others - any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients'. Even if a doctor is certain that a gift or hospitality will not affect his or her professional judgement, if it is other people's perception that it might do, then this could still have a negative impact by undermining those people's confidence in their own doctors, and public trust in the profession.

In the Dr Gallagher scenario, Ms Cieslak suggests that they go for a meal together. A situation like this might well result in a breach of the professional boundaries that should exist in a successful doctor/patient relationship.

...trust in the medical profession...

Not all personal relationships between doctors and their former patients involve an abuse of the professional relationship. It can be helpful for someone in Dr Gallagher's position to consider what would happen if the relationship broke up and a complaint were made about the doctor's conduct. A significant proportion of the complaints about doctors' alleged inappropriate relationships with patients come from the patient themselves after the relationship has ended, often acrimoniously, or from the patient's partner or ex partner - as happens in the case study. Doctors should ask themselves if they would be able to justify their actions if such a complaint were to be made about them.

However even if doctors think they have not abused their professional position, they must also consider how the relationship looks to others, and whether it might damage wider public trust in the medical profession. People must be able to disclose confidential medical information about themselves, and otherwise confide in their doctor without worrying that their doctor might make sexual or emotional advances.