THE DOCTOR AND SEXUAL BOUNDARIES
From the time of Hippocrates, the medical profession has acknowledged that the special relationship of trust between patient and doctor must not be misused by the doctor establishing any type of improper or sexual relationship. As stated in the Hippocratic Oath:
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations, with both female and male persons, be they free or slaves.1
This prohibition has been widely restated in recent times and is enforced by the threat of suspension or removal of the name of the doctor from the medical register if found guilty of such unprofessional conduct.2-6 The existence of this sanction and the historically low incidence of complaints against doctors possibly created the impression that sexual misconduct as a problem was rare. There is now considerable evidence from North America, Europe and Australia that this is not so.7-11 In the face of such evidence, it is imperative that the medical profession acknowledges and confronts the problem of sexual misconduct. This involves improved undergraduate and postgraduate education concerning sexual boundaries and the profession, with doctors taking personal responsibility for understanding the ethical issues, psychological and social dynamics and appropriate professional standards in relation to this professional area. It also will involve the medical boards and professional associations and colleges having in place responsive, fair, accessible and sensitive methods of handling complaints of sexual misconduct against doctors.
This chapter defines sexual misconduct and summarises what is currently known of the incidence of sexual misconduct. It discusses the theoretical causes of boundary violations, emphasising the psychological dynamics for the