Revised guidelines: Trust - the cornerstone of good medical practice

27 Nov 2018

Revised Medical Board of Australia guidelines on Sexual boundaries in the doctor-patient relationship take effect on 12 December 2018.

The guidelines remind doctors that trust in the relationship between doctors and patients is a cornerstone of good medical practice.

Sexual misconduct is an abuse of the doctor-patient relationship and can cause significant and lasting harm to patients.

‘Patients have a right to feel safe when they are consulting a doctor,’ Medical Board Chair, Dr Anne Tonkin said.

‘Patients trust doctors to act in their best interests, treat them professionally, protect their privacy and never take advantage of them,’ she said.

The updated guidelines apply to all registered medical practitioners in Australia and define the standards of ethical and professional conduct expected of doctors by the Board, their peers and the community.

They complement Good medical practice: a code of conduct for doctors in Australia and do not change the ethical and professional conduct expected of doctors.

Breaches of sexual boundaries in the doctor-patient relationship are one reason the Board refers doctors to tribunals for disciplinary action. In 2017/18, 10 cases involving allegations of serious sexual misconduct were decided by tribunals – all received an adverse finding.

‘It’s hard to believe that in 2018, there is still a need for the Board to issue guidance on the importance of sexual boundaries between doctors and patients,’ Dr Tonkin said.

‘While the vast majority of doctors in Australia provide the community with excellent medical care, a small number of doctors cause serious harm to patients when they do not maintain sexual boundaries,’ she said.

The revised guidelines replace the current guidelines, Sexual boundaries: guidelines for doctors. They follow a scheduled review, supported by wide-ranging stakeholder consultation.

The guidelines remind doctors that:

• it is never appropriate for a doctor to engage in a sexual relationship with a current patient
• a doctor must only conduct a physical examination of a patient when it is clinically indicated and with the patient’s informed consent
• good, clear communication is the most effective way to avoid misunderstandings in the doctor-patient relationship, and
• doctors are responsible for maintaining professional boundaries in the doctor-patient relationship.

The key changes to the guidelines include:

• a change in the title to make the scope of the guidelines clearer
• editorial updates that reorder the content, make it easier to read and clarify terms and definitions
• a new section on social media that complements the Board’s Social media policy
• a requirement for patient consent if medical students or anyone else is to be present during an examination or consultation
• advice that an unwarranted physical examination may constitute sexual assault. This includes conducting or allowing others, such as students, to conduct examinations on anaesthetised patients, when the patient has not given explicit consent, and
• replacing the term ‘chaperone’ with the term ‘observer’. The revised section on the use of observers reflects the advice and principles in Professor Ron Paterson’s report of the Independent review of the use of chaperones to protect patients in Australia, February 2017.

For more information

• Read the revised guidelines and watch the Board’s video: It's all about trust.
• Lodge an online enquiry form.
• For registration enquiries: 1300 419 495 (within Australia) +61 3 9275 9009 (overseas callers).
• For media enquiries: (03) 8708 9200.