Whilst there would be natural agreement amongst the community that a sexual relationship between a doctor and their patient is and ought to be seen as a breach of professional standards, a recent QCAT decision illustrates how a platonic relationship will amount to professional misconduct where the practitioner has failed to draw clear professional boundaries and abide by them.
It goes without saying that trust is fundamental in the doctor/client relationship.
“Patients need to trust that their doctor will act in their best interests, treat them professionally, not breach their privacy and never take advantage of them. Exploitation of the doctor-patient relationship undermines the trust that patients have in their doctors and the community has in the profession. It can cause profound psychological harm to patients and compromise their medical care.”
As part of that concept of trust doctors are expected to always act in their patient’s best interests. Issues such as the power imbalance between the practitioner and patient, the unique trust people place in their practitioner, the risk of emotional harm for patients subjected to sexual behaviour, the risk to the practitioner’s objectivity, and the risk to public confidence are of central concern.
In this case, the complaint against the practitioner was made by the patient's ex-wife (who accidentally became aware of the relationship), not the patient themselves after a breakup. And although the patient did not suffer harm as a result of the relationship it was the risk of harm that was found to be important, and it was found that the practitioner had failed to make the patient's care the practitioner’s primary concern.
In addition, there was an honesty issue which occurred upon the complaint being made, as well as an allegation that the practitioner had prioritised her own career aspirations (presumably in relation to a study that the practitioner was undertaking and in which she enrolled the patient).
In this case, whilst it might appear that the practitioner had engaged in a low-level breach of medical duty so far as the type of relationships was concerned, the level of breach was exacerbated by the fact that the practitioner was a psychotherapy practitioner treating the patient for mental health issues. In these circumstances, the Tribunal felt that there was a special dynamic of trust and support that existed between practitioner and patient, making the patient especially vulnerable. It was acknowledged by the Tribunal that there was potential for significant harm where boundaries were not maintained in this situation.
This case shows us how the importance of maintaining the professionalism of the doctor/client relationship benefits both parties. For the patient, it promotes their care and safety. For the practitioner it promotes better judgment, thus hopefully avoiding the very distressing situation of the practitioner causing a potentially actionable injury to someone who has usually come to them in an already vulnerable position.
To their credit, the practitioner recognised and acknowledged their lapse in judgment and agreed with the Health Ombudsman that a charge of professional misconduct was supported.
A hefty $15,000 fine was imposed on the practitioner by the Tribunal.