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.

Background

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. 

Scenario

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:

Dr Scott 

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.  
  • Raise concerns if the behaviour of a colleague amounts to a denial of patient’s or colleague’s rights (Good medical practice, paragraph 58) 
  • 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:

Advice helplines

Related content

Identifying and managing sexual misconduct This page gives advice on how to identify and tackle sexual misconduct and make sure appropriate boundaries between doctors, patients and colleagues are maintained.