Sex and the rural doctor: what if all your potential partners are patients?
The Medical Board of Australia has received a plea for more relaxed rules around sexual relationships with patients when it comes to rural doctors. The submission from the doctor, whose name has been withheld, was prompted by a consultation on proposed changes to the MBA’s sexual boundaries guidelines.
The draft guideline update proposes a number of changes. It features a new section on maintaining sexual boundaries with current patients, including guidance confirming that patients cannot consent to a sexual relationship with their treating practitioner due to the inherent power imbalance in the doctor-patient relationship.
The draft guideline remains somewhat vague on sexual relationships with former patients. It says such relationships “may be unethical and unprofessional for a doctor to engage in sexualised behaviour with a former patient, if this breaches the trust the patient placed in the doctor.” It adds that doctors “should recognise the influence they have had on patients and that a power imbalance could continue long after the professional relationship has ended.” When deciding whether a relationship with a former patient is inappropriate, the Board says it will consider a range of factors, including the type of care provided, the extent of the patient’s dependence in the doctor-patient relationship, and the time elapsed since the end of the professional relationship.
The new guideline extends its remit to non-patients as well, if the person happens to be close to a patient.
“A sexual relationship between a doctor and an individual close to the patient may be unethical if the doctor has used any power imbalance, knowledge or influence obtained as the patient’s doctor to engage in the relationship,” the guideline says.
But the anonymous submission to the MBA from the rural doctor says there needs to be clearer guidelines in the rural context.
“At present, if you are a single rural doctor, you can’t go out with anyone in town, because they are almost all your patients,” the doctor writes.
There needs to be clearer guidance for what should happen if you do want to go out with someone, the doctor says.
“Personally, I think saying that you can no longer look after someone and they will need to see another doctor if you are going to go out is fine. Otherwise, we are really making rural medicine an impossibility for single doctors.”
But it doesn’t seem very likely that any new guidelines will take into consideration the limited dating pool of rural doctors.
Peta Rutherford, CEO of the Rural Doctors Association, says the rules are as they are for good reason.
“There is a power differential in the relationship with a doctor and a patient and it needs to be recognised,” she commented on 2GB radio.
“The doctors themselves need to really think about what the situation is. Certainly if a patient has things like a mental health issue that you’re treating them for or if you’ve treated them for obstetrics or gynaecological conditions, it’s a no-go zone. If you’ve had a one-off consultation for an ingrown toenail, it might be a little different.”
Although the consultation period has now closed, you can still access the draft revised guidelines for sexual boundaries in doctor-patient relationships here.