Professional boundaries are an important aspect of clinical care. Registered healthcare practitioners must be able to practice within legal and ethical boundaries in respect of patients.
Specifically, paragraph 53 of Good Medical Practice states:
You must not use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them.
The current case deals with a hearing before the Medical Practitioners Tribunal Service (MPTS) where the allegation against the doctor related to breaching professional boundaries.
Dr Bogatcheva (Dr B) was a consultant GP at a private clinic in Harley Street. In June 2016 she allegedly began a relationship with Patient A, for whom she was providing consultancy services. Her employer raised concerns with her after it came to light that she had accessed Patient A’s medical records at 5am on a date in November 2016. Dr B had accessed the records after she reportedly became suspicious when Patient A’s ex-girlfriend moved into one of his apartments.
The General Medical Council (GMC) investigated the matter and it was referred for a hearing before the MPTS.
The MPTS Hearing
In short, the allegations put before the MPTS in relation to Dr B’s fitness to practise, were that:
- In or around June 2016 she commenced an improper emotional relationship with Patient A, and that this relationship was sexually motivated;
- On three occasions she inappropriately accessed Patient A’s clinical records; and
- On 3 November 2016, she wrote a referral letter for Patient A whilst she was in a sexual relationship with him.
Dr B admitted to being in a relationship with the patient but denied that it happened whilst he was under her care. Patient A gave evidence at the hearing and stated that he had text Dr B asking her if she would like to go out at the end of June 2016. His evidence was that at this time he had not seen her as a patient for a long time. He was clear in his evidence that Dr B did not encourage him to ask her out.
Patient A and Dr B subsequently bought a house together, had a son and are due to marry in 2019.
The Tribunal heard Dr B’s evidence and considered it to be credible in respect of her intentions towards Patient A. The Tribunal held that “They had only had two face to face consultations and emails and telephone calls were mainly concerned with arranging consultations and providing test results, all of which was expected by patients of a private clinic”. In addition, the Tribunal accepted that Dr B did not consider herself to be in an emotional relationship with Patient A in June 2016 “as she did not have any particular feelings towards Patient A at that time, but that she was keeping an open mind before meeting him for coffee”.
Although the Tribunal concluded that the coffee meeting was improper, whilst Patient A continued to be a patient, they concluded that, on the balance of probabilities, the meeting did not signal the start of an emotional relationship. In their view, that came later on - July 2016 at the earliest.
In short, the Tribunal concluded that Dr B started a relationship with Patient A after he was no longer a patient at the clinic and consequently found the first charge not proved. However, the Tribunal found the remaining charges proved.
The Tribunal went on to consider misconduct and impairment, and in light of the matters set out above, concluded that Dr B’s fitness to practise was not impaired. They did however consider that her actions marked a departure from the standards expected of a registered doctor, and imposed a warning on her registration. To clarify, the warning related solely to Dr B’s inappropriate access to Patient A’s clinical records.
Each case clearly turns on its individual facts. Whilst no finding of an inappropriate relationship was made in this case, that is clearly due to the fact that the Tribunal were satisfied that Patient A was no longer a patient of Dr B at the time they had entered into an emotional relationship. Nonetheless, this case is a stark reminder to the profession of how boundaries can be blurred and the importance of maintaining clear and defined professional boundaries to avoid any speculation and/or criticism.
This blog was written by Aguie Mbah, Legal Assistant and Sarah Atkinson, Associate in the Regulatory Department.