Leading Article: Doctors: a prescription for retaining our trust

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The Independent Online
Oh, doctor, I'm in trouble. Well, goodness gracious me. For every time that certain man was standing next to Sophia Loren, a flush came to her face. Peter Sellers (for he it was) made the pulse race principally because he was a doctor, and men of medicine are sex objects. Reassuring, authoritative physicians have an erotic pull much stronger than cognate professions, such as teaching or the law. Male doctors are the stuff of white-coated fantasy, stock Mills and Boon heroes; breathless women succumb to their soothing bedside manners, in fiction at least, as to no other masculine type.

That paragraph is couched in terms of male doctors because when members of the British Medical Association debate whether to change the rule of automatic suspension when charges of sexual relations with a patient are made, they are discussing a male problem. Women doctors are not prone to seducing patients: men occasionally are.

On the surface, even men having sex with patients is not much of a problem. The number struck off because they are found to have breached professional ethics by carrying on such a relationship is a small proportion of the total number of cases. But underneath lies a more profound question, not only for doctors, but also for the other great professions: how far can and ought they to stand out against the culture and stick with rules that may seem fussy and antiquated?

The case for changing the suspension rule is not strong. In the BMA's own words, there is an emotional inequality in the relationship between a doctor and patient which can easily lead to abuse and exploitation. Patients are, by definition, vulnerable, otherwise they wouldn't be in a waiting room at all: they are not well. The fact that words such as "seduce" are a little old-fashioned in describing most modern sexual relations is immaterial: whether they are seduced, or seducing, or mutually attracted, patients need to trust their doctor, as absolutely as any human relations allow.

A female patient might say: I have entered an affair with this man in full agreement; my consultation was a mere precipitating event. But the rules do not exist for her sake. They serve other patients, other doctors and the maintenance of a general confidence in propriety. Each and every GP belongs to a class of person who, empowered to press and prod other people's bodies, must never treat consultation as the antechamber to the bedroom. Patients have a uniquely individual relationship with their doctors, not encountered in any other profession, and anything that undermines their confidence in that relationship will ultimately undermine the doctor's ability to carry out his or her work.

If a doctor and a patient do embark on a relationship outside the consulting room, there is a simple remedy: change doctor. It may even - though probably rarely - be necessary to protect doctors against patients, enabling doctors to move patients from their register where their position is threatened by a patient's compromising behaviour.

The prohibition against medical liaisons is a good one, and members of the BMA should follow their leaders' advice and reject any change, even symbolical. However, they could ask for a little more flexibility on the part of the GMC. The GMC, of course, deals only with complaints. Doctors, too, are vulnerable; they enter affairs at their peril. Injuries to the heart can be more devastating than physical ailments. The ending of an affair can be a time when, however consensual it has been, lovers are out for revenge, and the GMC is to hand. Its panels need the wisdom of Solomon to judge the nature of relationships. Clearly a doctor who has had a series of short-lived affairs with patients deserves harsher judgement than one who, at the ending of a grand and long-lasting passion, has been denounced, say, by a lover's husband. The GMC procedure exists, let us not forget, for the sake of the public's assurance. That can as easily be served by the fact that proceedings take place as by any particular punishment. Breaches of ethics can and often should be marked by knuckle- rapping and fines as much as by suspension and the ultimate sanction of forbidding a doctor to practise.

In recent years, professions have been bated and battered. Government ministers never tired, it seemed, of quoting that passage from Adam Smith about how whenever butchers and bakers or apothecaries and lawyers got together in private they were conspiring against the public's interest. That attitude corrupted health and education policy, and thwarted the Conservatives' own efforts to reform the legal system.

Professionals should not be emancipated from constraints on their costs or measures of their effectiveness. But professional autonomy, including strong influence over their own ethical standards, is one of the cornerstones of a society that is not and is never going to be dominated by the state. Most of all, we entrust professional associations with the responsibility to ensure that their members can, indeed, be trusted.

That trust runs two ways. We extend our confidence to teachers, doctors, lawyers, engineers, architects. We give them our minds, our bodies, our possessions for repair, enlightenment or better disposition. We trust the organisations to which professionals belong (less so in the case of teachers, sadly) to regulate their members. We collectively assent to generous rewards and, especially for doctors, the highest esteem. We expect in return performance and sincerity.

That warmth and esteem are precious. It is because of them that doctors are subject to tight rules about their conduct. When they debate the standards expected of their peers, members of the BMA should bear this in mind. The rules inhibit a small number of individual doctors from a kind of self-indulgence. That is a small price to pay for retaining the public's deep respect.