Introduction

Being a doctor does not make a person a law-abiding model citizen. Doctors commit offences outside of professional practice, including sexual offences. Male (and, less frequently, female) doctors do so for similar reasons to others in society, and this should not be surprising.

A second group of doctors behaves in a sexually inappropriate manner with patients. The data from North America (Gartrell et al, 1986; Morrison & Wickersham, 1998; Bloom et al, 1999) and Australia (Quadrio, 1996) suggest that 3–10% of doctors admit to some form of sexual involvement with a patient. For each doctor there may be a number of patient victims. For example, it was estimated that around 70 women claimed to have been sexually assaulted by the consultant psychiatrist William Kerr (see Box 6.2, p. 66).

Gabbard (1999) has proposed a psychodynamic categorisation for doctors who behave inappropriately in a sexual manner and/or who offend. Evidence received by the Kerr/Haslam Inquiry (Department of Health, 2005) suggested that for doctors or therapists who sexually abuse patients, the most common type is the ‘predatory psychopath’ (see also Box 8.4, p. 99). Abel & Osborn (1999), in a North American study of cases of professional misconduct, found that 20% of the sample had a paraphilia (sexual deviation) which extended into their professional practice. A simpler method of categorisation (see Box 13.1) is to consider where the sexual misconduct/offending takes place, and with whom, as this helps in decisions on sanctions and the feasibility of remediation (Box 13.2).

Whatever the subtype, and however the misconduct itself is dealt with, the nature of these worrying misbehaviours means that there will be always be concern about future risks to patients. The guiding principle in the handling of sexual misconduct and offending is that patient safety must be paramount, not the professional career of the practitioner.

For each doctor, sexual misconduct and offending may result in one or all of the following: