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03 May 2019

The AMA has updated it guidelines on maintaining sexual boundaries between doctors and patients, which now includes a section acknowledging that the power imbalance may lead patients to feel vulnerable and exposed.

The AMA’s Patient Examination Guidelines 2012 and the Position Statement on Sexual Boundaries Between Doctors and Their Patients 2012 were recently updated as part of the AMA’s routine, five-year policy review cycle.

As there was a fair amount of repetition between the two documents, they have now been combined into one – the Guidelines for Maintaining Clear Sexual Boundaries Between Doctors and Patients and the Conduct of Patient Examinations 2019.

The AMA’s updated guidelines were written to be consistent with the Medical Board of Australia’s Guidelines: Sexual Boundaries in the Doctor-Patient Relationship, which was released in December last year.

In the AMA’s new document, it clearly states that doctors have an ethical and legal duty to maintain appropriate professional boundaries with patients.

Essentially, professional boundaries define the limits of the therapeutic relationship between doctors and patients not only in terms of physical space but also social, emotional and psychological space.

“There is a potential power imbalance in the doctor-patient relationship. While doctors have the highly specialised knowledge and skills patients require to obtain good quality health care, patients may feel vulnerable or are potentially vulnerable and exposed due to the very personal and physical nature of the doctor-patient relationship,” the Guidelines state.

“For example, patients who seek care may be sick, injured, anxious and distressed. Further, they may be asked to undergo a physical examination which may cause discomfort and embarrassment or be asked to provide very personal and sensitive information about their health and lifestyle or relevant information about their family members.

“Because of the power-imbalance in the doctor-patient relationship, it is essential that doctors adhere to very strict professional boundaries to ensure that patients feel confident and safe when seeking medical care. Maintaining appropriate professional boundaries facilitates trust in the medical profession, promotes patient care and protects both doctors and patients. 

“In order to maintain professional boundaries, a doctor should not use their professional position to establish or pursue a sexual, exploitative or other inappropriate relationship with patients or those close to patients such as their carers, guardians or close family members including spouses or parents of a child patient.

“Violating professional boundaries undermines the doctor-patient relationship and may cause psychological harm to patients and compromise their medical care. In addition, such violations undermine the trust the community has in the profession to act with professionalism at all times, may constitute criminal conduct and may be subject to police investigation as well as disciplinary action.”

The Guidelines also point out that doctors should be aware that professional boundaries apply not only to face-to-face patient consultations but also in the use of social media and other forms of electronic communication and consultation such as emails, text messages and telehealth.

And the Guidelines clearly state that a doctor must not engage, or seek to engage, in sexual activity with a current patient.

“This extends to behaviours of a sexual nature such as making sexual remarks, flirtatious behaviour, touching patients in a sexual way or engage in sexual behaviour in front of a patient as well as conducting a physical examination that is not clinically indicated or in the absence of patient consent,” the document states.

Specifically on examinations, the Guidelines state that it is essential for a doctor to gain consent from the patient and explain why it may be necessary.

“A doctor should not conduct an examination if the patient does not consent or the consent is uncertain (there may be an exception in emergency circumstances). Where the patient does not consent or the consent is uncertain, the doctor should reiterate the importance of the examination with the patient,” the Guidelines state.

“If practical, and with the patient’s consent, the doctor may offer the patient an observer or support person to be present during the examination. If the patient continues to refuse to consent to the examination, the doctor should defer the examination or refer the patient to another doctor.

“The patient’s refusal to undertake the examination should be recorded in the medical record along with any relevant discussion between doctor and patient. The doctor should record the recommended course of action; for example, defer the examination to another time, engage an observer or support person to be present during the examination or refer the patient to another doctor.

“If an examination is in progress and the patient withdraws consent, the doctor should cease the examination immediately. The doctor may wish to explore why consent has been withdrawn, defer the examination or refer the patient to another doctor. The patient’s withdrawal of consent should be recorded in the medical record along with any relevant discussion between doctor and patient. The doctor should record the recommended course of action.”

CHRIS JOHNSON

The full Guidelines for Maintaining Clear Sexual Boundaries Between Doctors and Patients and the Conduct of Patient Examinations 2019 can be accessed at: 

https://ama.com.au/position-statement/maintaining-clear-sexual-boundaries-between-doctors-and-patients-and-conduct

 


Published: 03 May 2019