Advice for a GP afraid of blurring the patient-doctor boundary


How to respond to a Valentines's Day gift.

Dr Matt Piccaver: Employ a zero-tolerance approach

We have very clear guidance on receipt of gifts, courtesy of the GMC. We can receive gifts providing they don’t affect the doctor-patient relationship. Guidance once again is very clear on relationships with patients. ‘No sex please I’m your doctor’ is the order of the day. We have clear boundaries as professionals over which we shall not cross. I would argue that the same should be said of our patients.

I have been asked if I would like to go for a beer by patients, but I have had to politely decline. I point out that I might be friendly, but I can’t be your friend. Aside from the occasional inappropriate comment from nonagenarians (much to my staff’s amusement) I’ve never been on the receiving end of amorous approaches from patients.

Personally, I would have a zero-tolerance approach to this sort of behaviour. Politely decline and advise the patient of your duties as a doctor. If this doesn’t change anything, I would ask them to see another doctor. Again, the GMC has robust guidance on how to go about ending your therapeutic relationship with a patient. The prospect of a patient somehow enjoying coming to the doctors for anything other than medical reasons makes me uncomfortable, and my career is worth too much to me to allow such behaviour to continue unchecked. It might sound hawkish, but from me, it’s ‘one strike and you’re out’.

Dr Matt Piccaver is a GP in Glemsford, Suffolk

sarah jarvis

Dr Sarah Jarvis: Politely refuse

It can be flattering when a patient wants to show you their appreciation but bear in mind that accepting a gift, particularly if the patient has romantic intentions, has the potential to be misconstrued by the patient or others.

The GMC says you must not encourage patients to give gifts that will benefit you directly or indirectly, but you can accept unsolicited gifts if it does not affect your behaviour. If you suspect the patient has romantic feelings for you it might be better to politely refuse the present.

You may decide to write to the patient explaining that you are unable to accept the gift because this would overstep the boundaries of the doctor/patient relationship, which is a professional one. This should hopefully resolve any misunderstandings at an early stage. You may wish to consider whether the patient’s care should be transferred to another GP at the practice, although you must provide emergency care if there is no one else available to see the patient.

If the patient continues to contact you such as through social media sites such as Facebook, or via unsolicited written letters or cards, keep a log of all contacts and get advice from your medical defence organisation on how to manage the issue.

Dr Sarah Jarvis is a medicolegal adviser at the Medical Defence Union

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