Maintaining personal and professional boundaries

Maintaining personal and professional boundaries

1

Good medical practice sets out the principles, values, and standards of care and professional behaviour expected of all medical professionals registered with us. Maintaining personal and professional boundaries builds on Good medical practice to provide more detail on our expectations of medical professionals in this area. 

2

The professional standards describe good practice, and not every departure from them will be considered serious. You must use your professional judgement to apply the standards to your day-to-day practice. If you do this, act in good faith and in the interests of patients, you will be able to explain and justify your decisions and actions. We say more about professional judgement, and how the professional standards relate to our fitness to practise processes, appraisal and revalidation, at the beginning of Good medical practice.

3

Appropriate personal and professional boundaries are essential between medical professionals and their patients, and between medical professionals and their colleagues. 

4

Patients must be able to trust that medical professionals involved in their care will behave appropriately towards them during consultations and not see them as a potential sexual partner, or as a target for abuse or harassment. 

5

Professional and respectful working relationships between colleagues are central to positive working cultures. It is essential that individuals feel safe and respected in their workplaces, that they feel able to speak up when they experience or witness negative behaviours, and that they are supported to do so. 

6

This guidance sets out our expectations in relation to personal and professional boundaries, respect for others, trust and vulnerabilities within the healthcare environment. 

7

The same principles of behaviour apply whether you are interacting in a face to face, telephone or online setting. You must also follow our guidance on Using social media as a medical professional.

Personal relationships with patients

8

Trust is the foundation of the partnership between healthcare professionals and their patients. Patients must be able to trust that those involved in their care will behave professionally towards them.

Current patients

9

You must not pursue a sexual or improper emotional relationship with a current patient. 

10

If a patient pursues a sexual or improper relationship with you, you should try to re-establish a professional boundary, if it is safe to do so. If trust has broken down and you find it necessary to end the professional relationship, you must follow the guidance in Ending your professional relationship with a patient

11

You must not use your professional relationship with a patient to pursue a personal relationship with someone close to them. For example, you must not use home visits to pursue a relationship with a member of a patient’s family. 

Former patients

12

Personal relationships with former patients may also be inappropriate depending on factors such as: 

  1. the length of time since the professional relationship ended (see paragraphs 13–14) 
  2. the nature of the previous professional relationship 
  3. whether the patient was particularly vulnerable at the time of the professional relationship, and whether they are still vulnerable (see paragraphs 15–18) 
  4. whether you will be caring for other members of the patient’s family
  5. whether the patient’s decisions and actions are influenced by the previous relationship between you (or could be seen to be) 
  6. whether you would be (or could be seen to be) abusing your professional position.

You must consider these issues carefully before pursuing a personal relationship with a former patient.

Timing

13

It is not possible to specify a length of time after which it would be acceptable to begin a relationship with a former patient. However, the more recently a professional relationship with a patient ended, the less likely it is that beginning a personal relationship with that patient would be appropriate. 

14

The duration of the professional relationship may also be relevant. For example, a relationship with a former patient you treated over a number of years is more likely to be inappropriate than a relationship with a patient with whom you had a single consultation.

Vulnerability of the patient

15

Some patients are likely to be more vulnerable than others because of their illness, physical or mental health, disability or frailty, or because of their current circumstances (such as bereavement or redundancy). Children and young people under the age of 18 years should be considered vulnerable. Vulnerability can be temporary or permanent.

16

The more vulnerable someone is, the more likely it is that having a relationship with them would be an abuse of power and your position as a medical professional. 

17

Whatever your role, you must not pursue a personal relationship with a former patient who is still vulnerable. If the former patient was vulnerable at the time that you treated them, but is no longer vulnerable, you must consider whether there are other factors that would make a relationship inappropriate (see paragraph 12).

Personal relationships with colleagues

18

Consensual and reciprocated personal relationships between colleagues are a private matter between individuals. However, it is important that professional boundaries are maintained, and the undertaking, and/or end of a relationship has no adverse impact on clinical practice or team environments.  

19

Higher risk factors for relationships between colleagues being seen as non-consensual (either during the relationship, or after a relationship has ended) might include situations with large differences in power levels between colleagues, or situations where training and career progression opportunities could be impacted.

Inappropriate sexual behaviours towards patients and colleagues

20

All forms of sexual misconduct in medicine, including all forms of sexual harassment, are always unacceptable, and can be criminal in nature (such as rape and sexual assault). 

21

If you suspect a medical professional or patient has committed rape, sexual assault or other criminal activity, you must report this in line with your workplace policy, or to a person who is in the position to act (see our guidance Raising and acting on concerns about patient safety). If you are in a formal leadership or management role you must make sure it is reported to the police and to any relevant regulatory body.

22

Inappropriate sexual behaviours may be carried out by medical professionals and patients. They can have devastating impacts on individual wellbeing, psychological safety, patient safety, and medical professionals’ careers. 

23

Examples of unacceptable sexual behaviours can include, but are not limited to:

  1. sexual or sexist comments, jokes, innuendo and ‘banter’
  2. suggestive looks or leering 
  3. groping or repeated unwelcome touching 
  4. sexual gestures
  5. a person discussing their own sex life 
  6. intrusive questions about a person’s private or sex life 
  7. sending sexually explicit emails, text messages or posts on social media
  8. displaying sexually graphic pictures, posters or photos 
  9. spreading sexual rumours about a person 
  10. propositions and sexual advances
  11. making promises in return for sexual favours
  12. excessive or unwanted compliments on a person’s appearance.

Sexual behaviour towards patients

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You must never make a sexual advance or display sexual behaviour towards a patient. Sexual behaviour – for example, making inappropriate sexual comments – does not necessarily involve touching the patient (see paragraph 23 which gives examples of sexual behaviours). 

25

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. 

26

You must offer support to any of your patients affected by a colleague’s breach of sexual boundaries. 

27

You should respect patient confidentiality when reporting your concerns, but the safety of patients must always come first. 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 you have already decided to disclose information in the public interest, or it is not appropriate or practical to ask for consent.

28

If you decide to disclose information in the public interest without consent, you must tell the patient of your intention to disclose the information, unless it is not safe or practical to do so. In all cases, you should only disclose relevant information. You must also follow our guidance Confidentiality: good practice in handling patient information.

Sexual behaviour by patients

29

If a patient behaves in a sexual way towards you, and you feel safe to do so, you should tell them that their behaviour is unacceptable and ask them to stop.

30

If the patient does not stop the behaviour, or you do not feel safe to challenge the patient or continue with the interaction,  you should excuse yourself from the encounter and seek help. 

31

You should report the incident in line with workplace policies and seek support if you need it. 

Sexual behaviours towards colleagues

32

Trust and respect are central to your professional relationships with colleagues. All healthcare professionals have a responsibility for the way they behave towards colleagues and for how they respond to individuals who have been targeted by sexually motivated behaviour. 

33

Certain working environments in medicine might increase the level of risk of unacceptable sexual behaviours occurring. These can include residential settings, nightshifts, conferences, gender imbalances in specialties, workplace cultures, and large differences in seniority or power levels between colleagues. The risk is also increased in environments where fear of reputational damage or organisational inconvenience is prioritised over holding perpetrators to account.

34

You must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress (see Good medical practice, paragraph 57). What we mean by acting ‘in a sexual way’ can include – but isn’t limited to – verbal or written comments, displaying or sharing images, as well as unwelcome physical contact (see paragraph 23 for examples).

35

If you have experienced inappropriate behaviours, and are able to do so, you should report the behaviour to your line manager, or a person or organisation able to investigate the allegation.

36

If a colleague tells you, or you become aware of inappropriate sexual behaviours within your workplace, you have a responsibility to take some action (Good medical practice, paragraph 58). For example, you could: 

  1. check in and offer support to anyone targeted or affected by the behaviour, and/or let them know that you feel that the behaviour you witnessed is unacceptable 
  2. challenge the behaviour by speaking to the person responsible – either at the time, if safe to do so, or at an appropriate time and place 
  3. speak to a colleague and/or consider reporting the behaviour in line with your workplace policy and our more detailed guidance on Raising and acting on concerns about patient safety. Before you report the behaviour you witnessed, try and make sure that the person who was targeted is aware of, and supports, your intention to report it.
37

If you have a formal leadership or management role, you must take active steps to create an environment where people can talk about concerns safely (Good medical practice, paragraph 76). This includes concerns about unacceptable sexual behaviours. If you are aware of such concerns you must act (in line with Good medical practice, paragraph 59) to:

  1. make sure such behaviours are adequately addressed 
  2. make sure people are supported where necessary, and 
  3. make sure concerns are dealt with promptly, being escalated where necessary. 
38

You must also follow our guidance Leadership and management for all doctors, which contains content on respecting colleagues, positive working environments and tackling discrimination (paragraphs 6–10 and 73–75).

39

Our Ethical hub pages on Identifying and tackling sexual misconduct contain further information and supporting resources.