Boundary violations and sexual exploitation: recognition, avoidance and management

All clinical professionals need to comprehend and work within professional boundaries. Boundaries must be understood, observed and respected by doctors, as all violations pose a risk of harm to patients. Some boundary violations, particularly those that are sexual or financial, can be career limiting – doctors may be struck off by the GMC. Psychiatrists and GPs are those most at risk.

All psychiatrists need to be able to specify safe and therapeutic professional doctor-patient relationships. Recognition of common and challenging situations is a first step towards the prevention and management of boundary violations. Educational supervisors are expected to raise these issues with trainees and indeed with anyone they supervise.

Although junior doctors may run into difficulties because they lack experience and because of the wider use of social media, the more severe problems are usually associated with men in mid-career. Sometimes boundary violations occur as an abuse of hierarchical power; sometimes they occur when individuals are more stressed at home or at work.

This module uses vignettes and interactive material to help you identify good practice in doctor-patient relationships, recognise and describe boundary violations and their associated harms, and learn how to avoid and manage such situations where they have occurred.