Introduction

The Medical Protection Society (MPS) is a provider of professional indemnity and advice to doctors, dentists and health professionals around the world. It is a mutual, not-for-profit organisation that offers its members (who number more than 265 000) help with legal and ethical problems that arise from their professional practice. These include clinical negligence claims, complaints, medical council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal-accident inquiries.

The MPS medico-legal advisers manage a substantial and varied caseload. The telephone advisory service fields more than 18 000 calls a year. This places the MPS and the other medical defence organisations (MDOs) in a unique position, as they are able to hear directly from practising clinicians how they are affected by allegations and subsequent investigations.

Scope

The doctor–patient relationship requires boundaries to function effectively. These same boundaries may at times be crossed, broken or perceived to be crossed or broken, often leading to the breakdown of the relationship. The General Medical Council (GMC) comments:

Trust is a critical component in the doctor–patient partnership: patients must be able to trust doctors with their lives and health. In most successful doctor– patient relationships a professional boundary exists between doctor and patient. If this boundary is breached, this can undermine the patient's trust in their doctor, as well as the public's trust in the medical profession. (GMC, 2006).

Just as there are many different types of boundary, so there are as many ways for doctors to find themselves on the wrong side. Such transgressions can have significant consequences for the immediate therapeutic relationship and for the doctor's working life in general. The threat to the wider public confidence in the profession has resulted in regulatory bodies taking boundary infringements extremely seriously.

It is sexual boundaries that are thought of most often. Doctors who commit sexual crimes against their patients clearly raise concerns about public confidence in the profession and attract extensive media attention, but there are many more common transgressions, for instance treating a family member or taking part in an apparently consensual sexual relationship with a patient.