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The Royal College of Psychiatrists Improving the lives of people with mental illness

Abuse of the Doctor-Patient Relationship

Edited by Fiona Subotsky, Susan Bewley and Michael Crowe

Price: £25.00

College members' price: £22.50

Published: Nov 2010

Format: Paperback

Number of pages: 256

ISBN: 9781904671374

Abuse of the Doctor-Patient Relationship

The doctor–patient relationship is fraught with risk. Patients may be at risk from a doctor who misuses their position of authority, or is unclear where the appropriate boundaries lie. Doctors risk disciplinary or criminal proceedings when this happens. This book aims to address these risks, to assist clinicians in their daily relationships with patients, and to improve patient safety.

The authors examine the ethical principles and how these may be taught; prevalence of abuse; regulation and sanctions; management and governance; remediation; and the roles of the different organisations that may be involved, such as the General Medical Council and medical protection societies.

  • Practical guide to help clinicians avoid boundary violations and improve patient safety.
  • Expert contributions from a wide range of professionals.
  • Special focus on abuse by nurses, psychotherapists, sexual therapists and gynaecologists.
  • Extensively illustrated with case examples.
  • Includes professional guidelines.


A multidisciplinary approach makes this book useful for all doctors and medical trainees, especially general practitioners and gynaecologists, as well as all mental health professionals, nurses, social workers and their teachers and students. Health service managers and regulators, and their legal advisers, will also find this indispensable.

About the editors:

Fiona Subotsky - Consultant Child and Adolescent Psychiatrist, Kings College Hospital, London.

Susan Bewley - Consultant in Obstetrics and Gynaecology at St Thomas' Hospital, London.

Michael Crowe - Consultant Psychiatrist (private) specialising in sexual and relationship therapy, London.

"An important addition to our literature on this topic. I found this book to be well written, timely, comprehensive in scope, and of interest to anyone who wants to learn more about this sensitive and significant topic ...useful not only to physicians but also to a wide audience of nurses, social workers, psychologists, other healthcare professionals, and the lay public."

- The Journal of Nervous and Mental Disease





Introduction: Mapping the Territory



Ethical Principles and Professional Trust


The Patient's Perspective


Teaching Ethics and Ethical Behaviour to Medical Students


With the Benefit of Hindsight: Lessons from History


The Prevalence of Boundary Violations between Mental Health Professionals and their Patients


Psychiatry: Responding to the Kerr-Haslam Inquiry


The General Practitioner and Abuse in Primary Care


Boundaries and Boundary Violations in Psychotherapy


Sexual Therapies: Vulnerabilities and Boundaries


Obstetrics and Gynaecology: A Special Case?


Nurses as Abusers: A Career Perspective


Medical Management: Governance and Sexual Boundary Issues


Dealing with Offending Doctors: Sanctions and Remediation


Defending Doctors: The Protection Society's Experience


Regulation and its Capacity to Minimise Abuse by Professionals


The Role of the General Medical Council




Vulnerable Patients, Safe Doctors: Good Practice in our Clinical Relationships


Maintaining Boundaries


Other Psychiatric Codes


Examples of sexualised behaviour by healthcare professionals towards patients or their carers


Fitness to Practise Cases


Web Resources

"This book clearly maps the territory in the complex areas of boundaries between patient and professional (all regulated healthcare professions, not just doctors). Experts are drawn in from general practice, psychotherapy, sexual therapies and nursing; obstetrics and gynaecology; as well as teachers, ethicists, medical managers and healthcare regulators. ... The book contains important guidance on the prevention of boundary violations that vulnerable doctors can blunder into, perhaps due to a sometimes toxic combination of overenthusiasm and naiveté."

- British Journal of Psychiatry

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