By Michelle Roberts
Health reporter, BBC News
The public is being asked whether doctors should be able to have sexual relationships with ex-patients without fear of reproach.
The guidance sets out boundaries
The General Medical Council, the body that regulates doctors, wants to gauge public opinion before updating its advice to doctors.
Currently, it strongly advises doctors against dating patients.
But its new draft acknowledges that a blanket ban is too strong.
It wants to strike a balance between protecting vulnerable patients from abuse and giving doctors autonomy.
The GMC's 2001 guidance says doctors must not allow personal relationships to undermine the trust which patients place in them.
In particular, doctors must not use their professional position to establish or pursue a sexual or improper emotional relationship with a patient or someone close to them.
The new draft maintains that doctors should not use their professional position to pursue relationships, but acknowledges that there might times when dating an ex-patient is permissible - something not covered by the 2001 guidelines.
The draft advises: "If exceptional circumstances arise in which social contact with a former patient leads to the possibility of a sexual relationship beginning, you must give careful consideration to the nature and circumstances of the relationship."
Doctors should ask themselves whether they and the ex-patient may be continuing a relationship based on emotional dependency, reflecting the imbalance of the previous professional relationship.
Factors such as whether the professional relationship has ended and whether the doctor is caring for any of their prospective lover's family would also have a bearing.
On its website, the GMC asks doctors and the public whether they agree with the statement "Pursuing a sexual relationship with any former patient will usually be inappropriate".
Two thirds of the 69 people who posted responses said they disagreed with the statement.
One explained: "Proximity and familiarity are important factors leading to the development of relationships.
"Doctors, naturally do fall in love, and this could involve a former patient.
"There are cases in the UK and abroad where doctors have entered into successful marriages with patients."
Many thought that, once the professional relationship was terminated, any sexual relations should be a private matter between two consenting adults.
The updated GMC guidance is due in November
Others also questioned whether a power imbalance existed between doctors and patients nowadays.
One doctor said: "Doctors make life saving and serious decisions every day of our working lives - why then would the GMC assume that we are not able to make a decision on who we see outside of our professional lives?"
Another said: "There are of course many patients who do not need to be protected and who themselves are capable of considering the facts and deciding whether they wish to pursue a relationship with a doctor who treated them at some time in the past."
A member of the public said: "I always assumed that it was perfectly okay for a doctor to date a former patient.
"A friend of mine has a relationship with somebody who was once her doctor and nobody questions this, neither his medical colleagues or any of our friends."
A GP working in the Shetland Islands pointed out that, for some people, the guidance might be completely impractical.
"Should I be in a position where I was looking for a partner, a vast proportion of the local population would be people who at one time or another have been 'my patient' however tenuously or briefly."
Many of the respondents said it was hard to generalise and that each case should be judged individually. Some criticised the guidance for not being precise enough.
Stating that pursuing a sexual relationship would "usually" be inappropriate might be capable of deliberate misinterpretation by the disreputable, said one respondent.
Some questioned how any ban could be enforced. Others suggested a precise waiting or cooling-off period could be recommended in the guideline to ensure a suitable gap between the end of the professional relationship and the beginning of a personal relationship.
The Royal College of General Practitioners said some practical interpretation might be needed.
"The advice that there should never be a sexual relationship with an ex-patient would mean that a doctor who develops a relationship with an ex-patient, who is also a social contact, can never marry or consummate the relationship even if the new partner leaves his or her list.
"Illustrative examples of what is appropriate and what isn't would help here," said a spokeswoman.
The British Medical Association advises: "As a general principle, sexual relationships or emotional dependence between doctors and their patients or the close relatives of patients must be discouraged."
The BMA says the fact that doctors have access to past health information about their patients and see them when they are feeling ill and vulnerable puts patients at a disadvantage.
"Intimate personal relationships can arise in good faith when doctors and patients initially meet in a purely social setting but, even so, the doctor can be very vulnerable to complaint if the relationship ends acrimoniously.
"Doctors who discover that a person with whom they are developing a personal or sexual relationship is also their patient should immediately cease the relationship or take reasonable steps to ensure that medical care is provided by another practitioner," it says.
The BMA spokeswoman added: "We would be very concerned if the GMC ruled out completely any relationship between a doctor and an ex-patient.
"There are example of bona fide relationships. The BMA believes each case should be judged individually."
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