Thursday, 12 April 2007

No sex please, we're British doctors

The Times reported yesterday that "doctors and nurses are likely to be banned from dating former patients unless the professional contact with them was minimal". It seems that draft guidelines are being drawn up by the Council for Healthcare Regulatory Excellence, the new quango that now oversees the General Medical Council, the General Nursing & Midwifery Council and seven other healthcare regulators.

Please note that hubristic word "Excellence", so very New Labour. Other countries (run by lesser breeds without the law) may have ordinary healthcare regulators, but here in Britain we have Excellent healthcare regulators. And how do they manifest their Excellence? By being as restrictive as they can.

For a very long time the rule was that if a romantic attraction should start to develop between a GP and a patient then the patient should register with another practice before the relationship got too serious. This seemed to strike a sensible balance between the liberty of individuals and the possibility of exploitation. The current guidance on the GMC site gives more detail, and advises that a sexual relationship will not be appropriate if the patient was in a particularly vulnerable state during the time of the doctor-patient relationship, and especially if they are still vulnerable. This seems sensible to me. But I suspect that the CHRE will wish to demonstrate their Excellence by banning any such relationship, no matter how free from coercion.

The good burghers of the CHRE know that they are unlikely to be criticised for being too harsh on doctors and, contrariwise, are at risk of censure if their rules do not exclude every misdemeanour that could possibly occur. So rules will inevitably be tightened and standards ratcheted up until ordinary mortals are not able to comply with all of them all of the time. Doctors, being human, will sometimes fail to meet these stringent standards, and no doubt one or two will be shot from time to time pour encourager les autres.

The Times also reported that GMC guidance released in October 2006 states that doctors' "right to practise is in jeopardy if they... look at pornography". I cannot find details of this guidance on the GMC site, so I don't know if it is still safe to look at my gynaecology textbooks without a chaperone. More seriously, should I avoid going to see films rated at 12 or 18, viewing advertisements on continental television stations, or opening any of the Sunday colour supplements? Sexualised images are used almost everywhere in our culture to sell things, and marketing agencies wouldn't use them if they didn't work. There seems little doubt that many men and some women enjoy looking at pornographic images. We can argue until the cows come home about whether they debase the photographed or deprave the viewer, but society seems to have decided (albeit by default) that a little light pornography is good for business. In this brave new world, only the doctor is expected to turn his head aside and look the other way.

No doubt the GMC guidance (if I could find it) is reasonable, and speaks of addictive use, or viewing extremely hard core material (involving violence, mutilation, death or children). But I fear that CHRE guidance when it comes will be extremely prohibitive, and will of course be administered by lay people with a civil burden of proof. "GP probably viewed picture of naked posterior, struck off".

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