Do doctors get crushes on patients

A doctor who said he could not help having affairs with his patients was struck off the medical register at his own request yesterday morning. "I have a fundamentally flawed personality which makes me permanently unfit to be in a position of trust as a GP," John Razzak wrote to the General Medical Council. "I have had affairs with patients over which I seem to have no control."

The formal end to 46-year-old Dr Razzak's career in medicine came just five days after Staffordshire GP Keith Bevan was thrown out of the medical profession for a 14-month affair with a farmer's wife, whom he seduced in his surgery while her husband was sitting in the waiting room. "She was avid for sex and her husband was happy to watch the telly," Bevan, 57, told the GMC hearing which concluded that his behaviour "undermines the confidence which the public is entitled to place in members of the medical profession and constitutes a gross abuse of your position."

In July, the GMC ejected Iain MacLeod, a 66-year-old GP who rode around Moffat in Dumfriesshire in a Jaguar with the number plate TSM 1T, which stood for "The Sexiest Man In Town". He was struck off over a 22-year affair with a woman he had been treating for depression which, it was said "contributed to the distress she has suffered over a significant part of her life". In February, Dr Anthony Leeper, 48, who admitted an 11-month sexual relationship with a patient, escaped with a two-year supervision order.

These are just a few of the doctors who have recently got caught. Typically they are middle-aged and male. Research in the US has shown that one-in-10 family doctors has had a sexual relationship with a patient. Having sex with a patient is completely off-limits. Every doctor, certainly in the UK, knows it is a career-ending offence.

Yet, medical students who were asked about whether they would have relationships with their patients, for a study published in the Journal of Medical Ethics this month, were equivocal. If they were a GP on a remote Scottish island and were asked, by a patient they had just about finished treating for a skin condition, to come to dinner, in a way that suggested her interest was more than conversation, what would they do? Nearly half (40%) said they couldn't see the harm.

Many of us might feel sympathetic. What's a doctor to do on a windswept rock where there might be more sheep than potential partners? But no. John Goldie, an Easterhouse GP and senior tutor at the University of Glasgow, who devised the study, is uncompromising. "There is a power imbalance in the relationship, it is not a relationship of equals and it can never be," he says. It is doubtful, he says, that any patient can ever truly give consent to a sexual relationship with her doctor.

This isn't about the sexy registrar with the white coat, gentle hands and impeccable bedside manner. It's not about Carry On Doctor frolics or seductive soap opera GPs. Fiction has frequently woven sex into the life-and-death tapestry of medicine, but the reality features men and women who go to their doctor because of physical and often emotional vulnerability. What they find, from their doctor, is sympathy, care and concern. It can be devastating.

Sigmund Freud noted that many of his female patients fell in love with him. He called it transference. What was happening, he said, was that they were casting him as somebody in their past life, projecting on to him the feelings of love and desire that they had experienced for other men.

"If you help a patient who is having problems, they are so grateful they sort of fall in love with you," says Claire Rayner, president of the Patients Association. "They are not, but they think they are. They transfer all their emotions to the person who has helped them.

"Doctors are attractive figures. They have all this knowledge and they care about you and you get the feeling they care more about you than they do. Getting a crush on them is easy. I did it. It has happened to me that I have been looked after really well and thought: 'Oh you are lovely.' "

It happens most with psychiatrists, gynaecologists and GPs - those doctors who spend most time with patients and are likely to talk over problems beyond the physical. But this is not a one-way street. The doctors most likely to have a sexual relationship with a patient are male, middle-aged and may have problems of their own.

The damage that can be done is clear from the GMC cases, which will only have got that far because they are the most serious. The woman with whom MacLeod had an affair over two decades was being treated for depression. Dr Leeper's affair was with a patient who came to him with anxiety and emotional problems. The woman Bevan seduced had marital problems and wanted him to prescribe Viagra for her husband, a farmer whose livelihood had been badly hit by foot and mouth disease.

In every case, the woman was vulnerable and looking for help. There can be no equal relationship if it is born in the surgery or consulting room, says Dr Goldie. He says there is no way out - asking the patient to switch to another doctor is also unacceptable. "It's a bit of a grey area," he acknowledges, but because the woman was once a patient, transference can have occurred and the power imbalance exists. "There is no evidence that it disappears," he says.

In an age when sexuality and sexual expression rule and when marriages last for ever briefer periods, it may be seen as a hair-shirted hard road for the doctor on the remote Scottish island, if not the rest of the profession. But Dr Goldie takes no prisoners: "With professionalism comes boundaries," he said. He says there is a need for much more education and discussion among doctors to help them deal with the doctor/patient relationship, including asking students their attitudes at the start of their training and, if necessary, attempting to change them. Because, at the end of the day, this is not about sex between a man and a woman, but potential - even if unknowing - exploitation of vulnerability. And as Hippocrates said, the first duty of a doctor is to do no harm.