Sexual relationships between health practitioners and former patients

To the Editor: “Patients often suggest a ‘social meeting’ after you have treated them. It’s a slippery slope” — quote from an Australian medical student.1

A review published in The Medical Journal of Australia of what constitutes misconduct in health professional–former patient sexual relationships highlights the variation between different health professional codes and the repercussions.2 The article notes the lack of national guidance or codes of conduct for health professional students regarding this or similar professional boundary issues.2

The lack of knowledge on this and other professionalism dilemmas faced by students led to the Professionalism Opinions of Medical Students (PoMS) study.1 We obtained ethics approval from the University of Western Australia (Ref. RA/4/1/9278) to conduct the PoMs study using a mixed methods approach with a validated online survey1 to triangulate how the Australian public (n = 503), qualified doctors (n = 809), and medical students (n = 2602) viewed a range of professionalism dilemmas that medical students may encounter. Participation was voluntary and anonymous. Medical students were informed about the study through their medical school. Doctors and the public were informed about the study using media and social media resources. The surveys were closed when recruitment had plateaued.

One of the scenarios asked for respondents’ opinions on how acceptable it would be for a medical student to embark on a romantic relationship with a former patient, and if student participants had encountered a similar situation.

To determine whether unconscious bias influenced participants’ opinions, there were two randomly administered versions with female or male protagonists (no same‐sex version was included). The scenario is described below:

A male/female medical student bumps into a 25‐year‐old woman/man at an evening concert. The student had taken her/his history and performed an abdominal examination in the emergency department a fortnight ago when she/he had attended with abdominal pain. The pair get chatting and the woman/man invites the student back to her/his flat for “somewhere quieter for a drink”. The male/female student accepts the invitation. How acceptable is this student’s behaviour?

Almost 4% of medical student respondents (n = 84) reported encountering a situation similar to the one described.

Using the ${\chi }^2$ test to compare the responses, there were significant differences in how the three demographic groups viewed this scenario. Notably, more than 50% of the public (n = 237), compared with more than 37% of the students (n = 896) and 29% of the doctors (n = 215) who completed this section of the survey considered this behaviour as acceptable (P < 0.001), regardless of the gender of the protagonist. Doctor participants were the only group to have no gender bias for the acceptability of the protagonist’s behaviour.

Medical students’ opinions were intermediate, but were significantly influenced by their stage in the course. Survey participants in the early years of the medical course expressed opinions that aligned more with the public’s responses (478/1099, 43%), but the responses of students in the later years of the course were closer to the views expressed by qualified doctors as to how acceptable they considered the behaviour to be (412/1195, 34%; P < 0.01), supporting the concept of professional identity formation.

The PoMS results demonstrate that medical students encounter patient sexual relationship dilemmas and are often unsure about how to manage this — a situation compounded by a lack of national guidance or codes of conduct.

We endorse the suggestion that governing bodies provide clearer guidance to health professionals,2 but also advocate that health professional students are provided with explicit guidance on this and on how to apply the other behavioural expectations of good medical practice3 as a student.