Power imbalance in clinical placement
This case study was developed with the assistance of The 1752 Group and is based, with permission, on 'Sally's’ real-life story.
Content warning – This article includes mentions of sexual harassment, rape and violence.
Sally is a medical student. Her first clinical placement, which is four months long, requires her to live in hospital accommodation at some distance from her home, taking her away from her family, friends and support systems. Dr Scott is the main consultant on her ward.
Sally begins to receive persistent attention from Dr Scott, such as phone calls, telling her she is a brilliant student and offering to walk her home from work. Although hesitant at first, Sally is pleased that she has impressed him on the wards and flattered that such an experienced consultant would be interested in her.
Sally feels reluctant to refuse Dr Scott’s support, so she agrees to meet with him outside of work, eventually entering a relationship with him. Although Sally tells him that she does not want to have sex with him, Dr Scott frequently tells her that he does not accept this. Dr Scott persuades her to keep this relationship secret, but in their small community, Sally thinks that their colleagues and friends must be aware.
When Sally moves on to her subsequent placement, the relationship ends. She visits Dr Scott once more, during which he rapes her and threatens her with harm if she tells anyone.
Sally looks back on the relationship and questions if it was, in fact, fully consensual; she feels coerced. Sally develops PTSD, and this very seriously affects her studies, eventually ending her career. She is concerned that Dr Scott is regularly targeting students but doesn’t know what she can do or who she can contact to try and stop this from happening to other students in her position.
Guidance and advice:
- Doctors must follow the law. Doctors must not bully or harass or unfairly discriminate against colleagues (Leadership and management for all doctors, paragraph 7). Doctors must treat colleagues fairly and with respect (Good medical practice, paragraphs 36).
- Sexual misconduct encompasses sexualised and predatory behaviours of doctors towards students, including 'grooming' and boundary-blurring of professional relationships into personal ones, as well as sexual coercion and assault. It can be a criminal offence and it is never appropriate.
- You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession (Good Medical Practice, paragraph 65).
If you suspect a doctor is abusing someone:
- Be aware that relationships between colleagues with large differences in power levels can create an environment where coercion can take place leading to sexual misconduct.
- You should raise concerns if the behaviour of a colleague amounts to a denial of patient’s or colleague’s rights (Good medical practice, paragraph 59)
- You may be reluctant to report a concern for several reasons. For example, because you fear that nothing will be done or that raising your concern may cause problems for colleagues; have a negative effect on working relationships or have a negative effect on your career. However if you are hesitating about reporting a concern for these reasons, you should bear in mind that you do not need to wait for proof – you will be able to justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels, even if you are mistaken (Raising concerns, paragraphs 9, 10)
- You must follow and keep up to date with your organisation's policies about employment, equality and diversity. Doctors must get advice on these issues if they need it (Leadership and management for all doctors, paragraph 8).
Help and support:
- Our ethical hub pages on Speaking up provides tools and advice to support you in raising concerns. This includes signposting to organisations such as the Freedom to Speak up Guardians, who can help healthcare workers to speak up about anything that gets in the way of patient care or affects working life.
- Help and support is available for anyone affected by sexual misconduct in the workplace:
- 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.
- Scottish Women's Rights Centre provides free and confidential legal advice to women and girls in Scotland
- Domestic and Sexual Abuse Helpline is a free and confidential support service for those affected by sexual abuse in Northern Ireland.
- 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.