About 60 cases alleging improper sexual behaviour and relationships between doctors and their patients are brought before the General Medical Council each year, but very few are successful. The most recent figures show that between 1990 and 1992 four cases of "improper relationship" got as far as the Professional Conduct Committee.

In 1991, of the 1,087 complaints received by the council, 61 were for improper relationships. None was referred to the PCC. In 1992, again the PCC heard none of the 65 cases concerning improper relationships. In total, two doctors were struck off during the three-year period.

Jean Robinson is a lay member of the GMC for 14 years, a former member of its complaints panel and vice-president of the Patients' Association. She says that Dr Michael Crowe, who called for the British Medical Association's rules on sexual conduct to be relaxed this week, should take a closer look at the statistics. She says: "Only a small percentage of such patients get as far as complaining. Many are too devastated. What the GMC sees is the tip of the iceberg. Of those that do reach the GMC at all, only a small minority even reach the Preliminary Proceedings Committee, and the case has to be serious and provable before it is passed to the PCC. The committee does not automatically strike doctors off the register if a case is proved."

And even when there is considerable evidence the PCC, which is made up of mostly male doctors, is hard to convince, she says. In her six years on the panel Mrs Robinson says she never sat with more than two other women.

"Under the rules the majority are elected by their fellow doctors. Most will be men. Sometimes I was the only woman on the panel and I never sat with more than two others.

"The claim by some doctors that the GMC is acting in a draconian fashion or doing terrible things to doctors which are unjustified or untrue is absurd. One might say that it is the public which is not getting adequate protection because everything suggests that the structure and the provisions of the act bend over backwards to protect the doctor from the ultimate penalty."

Outsiders, she says, too readily assume that the patient "chose" a relationship as an equal. Now that so many GPs offer "counselling", the risks of manipulation which take place in psychotherapy become more likely.