Abuse of the Doctor-Patient Relationship

A practical guide to help clinicians avoid boundary violations and improve patient safety.

Fiona Subotsky (Edited by), Susan Bewley (Edited by), Michael Crowe (Edited by)

9781904671374, Royal College of Psychiatrists

Paperback / softback, published 1 November 2010

252 pages
23.5 x 15.7 x 1.4 cm, 0.45 kg

'This book clearly maps the territory in the complex areas of boundaries between patient and professional (all regulated healthcare professions, not just doctors). Experts are drawn in from general practice, psychotherapy, sexual therapies and nursing; obstetrics and gynaecology; as well as teachers, ethicists, medical managers and healthcare regulators. … The book contains important guidance on the prevention of boundary violations that vulnerable doctors can blunder into, perhaps due to a sometimes toxic combination of over-enthusiasm and naiveté.' British Journal of Psychiatry

The doctor-patient relationship is fraught with risk. Patients may be at risk from a doctor who misuses their position of authority, or is unclear where the appropriate boundaries lie. Doctors risk disciplinary or criminal proceedings when this happens. This book aims to address these risks, to assist clinicians in their daily relationships with patients, and to improve patient safety. The authors examine the ethical principles and how these may be taught; prevalence of abuse; regulation and sanctions; management and governance; remediation; and the roles of the different organisations that may be involved, such as the General Medical Council and medical protection societies. This is a practical guide to help clinicians avoid boundary violations and improve patient safety.

Foreword
Introduction: mapping the territory
1. Ethical principles and professional trust
2. The patient's perspective
3. Teaching ethics and ethical behaviour to medical students
4. With the benefit of hindsight: lessons from history
5. The prevalence of boundary violations between mental health professionals and their patients
6. Psychiatry: responding to the Kerr-Haslam inquiry
7. The general practitioner and abuse in primary care
8. Boundaries and boundary violations in psychotherapy
9. Sexual therapies: vulnerabilities and boundaries
10. Obstetrics and gynaecology: a special case?
11. Nurses as abusers: a career perspective
12. Medical management: governance and sexual boundary issues
13. Dealing with offending doctors: sanctions and remediation
14. Defending doctors: the protection society's experience
15. Regulation and its capacity to minimise abuse by professionals
16. The role of the General Medical Council
Appendices: 1. Vulnerable patients, safe doctors: good practice in our clinical relationships
2. Maintaining boundaries
3. Other psychiatric codes
4. Examples of sexualised behaviour by healthcare professionals towards patients or their carers
5. Fitness to practise cases
6. Web resources.

Subject Areas: Psychiatry [MMH]