Four out of 10 medical students feel they can justify having a sexual relationship with a patient, suggests a small study in the Journal of Medical Ethics. Furthermore, their views seem to change little as they move through their training, shows the study.
The researchers monitored the responses of 62 medical students to a validated questionnaire on four separate occasions during the course of their training. The questionnaire was designed to highlight different ethical issues in health care, using 12 vignettes (EHCI).
One of these revolves around a general practitioner taking up a post on a small, remote Scottish island. S/he is invited to dinner by a patient coming to the end of a period of lengthy treatment. The patient is a member of a local interest group to which the doctor also belongs.
The students were asked to say whether they would accept or decline the invitation, and to give their reasons why. They were assessed before and after year 1, after year 3, and after year 5 at the end of their training, which included ethics.
Sixty per cent of the students said they would refuse the invitation, mostly on the grounds that it was unethical or would compromise the doctor-patient relationship. Other reasons included abuse of power and a feeling that such behaviour would be unprofessional.
But four out of 10 students said they would accept the invitation. The principal reasons given were the difficulties of meeting a future mate in such a setting, the belief that professional and private lives can be kept separate, and the feeling that this would be acceptable if the patient changed practice. These views remained fairly constant over time.
The authors cite international studies showing that sexual relationships between doctors and their patients, particularly in general practice, gynaecology, and psychiatry, are relatively common.
US research suggests that one in 10 family doctors surveyed had had sexual contact with at least one patient, while an Australian study found that almost a third of family doctors questioned knew of a colleague who had had sex with a patient.
"Particularly vulnerable are socially isolated, middle aged men experiencing a mid life crisis, who are eminent in their field," say the authors, pointing out that the risk of sexual misconduct increases with age, rising 44% with every decade.
They conclude that far too little attention is paid to the issue of sexual or improper relationships in medical training, and that these issues need to be made more explicit.
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