The Medical Board of Australia has announced new sexual boundaries guidelines, which will come into effect from 12 December 2018 and apply to all registered doctors across the country.
The new guidelines define the ethical and professional conduct standards expected of doctors, complementing those set out in the profession’s code of conduct.
What has changed?
Of particular note, the guidelines:
- confirm that patient consent is required if medical students or anyone else is to be present during an examination or consultation (section 7)
- state unwarranted physical examinations or inappropriate touching during a consultation may constitute sexual assault – this includes conducting or allowing others, such as students, to conduct examinations on anaesthetised patients when they have not given explicit consent (section 3)
- have a new section on social media, in line with the Medical Board’s social media policy (section 8), which reaffirms doctors should interact with patients via the usual professional healthcare communication channels and not through social media, and
- replace the term ‘chaperone’ with the term ‘observer’ in response to advice from the Paterson Chaperone Review (section 7.1).
Guidelines’ guidance for doctors
Avant made a submission to the Medical Board on the proposed guidelines during the consultation in February 2018 with several of our suggestions having been adopted – you can view the submission here.
The guidelines emphasise that good communication and trust are the foundations of the doctor-patient relationship. We recommend that all doctors read the revised guidelines to refresh their understanding of professional boundaries and for guidance on:
- informing patients of the nature of and need for all aspects of clinical management, including the need for examination and investigations (sections 1.2)
- explaining to patients why it may be necessary to ask questions about a patient’s sexual history or preferences (section 3.1)
- warning signs that a professional relationship is starting to cross boundaries (section 4)
- maintaining sexual boundaries with former patients and individuals close to the patient (sections 5 and 6)
- the spectrum of behaviours that could breach sexual boundaries (section 3)
- mandatory reporting obligations for sexual misconduct (section 9)
- undertaking physical examinations, including the use of observers (section 7).
Being mindful and communicating clearly, effective risk management
Breaching sexual boundaries is always unethical. However, we have seen cases where complaints of boundary violations stem from a misunderstanding by the patient of the reason for an intimate examination.
Doctors should be mindful of the potential for misinterpretation and misunderstanding when discussing or performing intimate examinations. As noted in the new guidelines, good, clear communication is the most effective way to avoid misunderstandings in the doctor-patient relationship.
If a patient declines to have an examination that you believe is clinically indicated, explore the reasons for their refusal, explain the potential consequences and offer an alternative, such as seeing another doctor in your practice or offering to have an observer present. Remember to document well any refusal of examination or treatment.
Avant’s Learning Centre has a number of resources on effective communication, including an online course exclusive to members.
If you are concerned about a potential breach of the guidelines, call our Medico-legal Advisory Service (MLAS) on 1800 128 268 for expert advice, 24/7 in emergencies.