Venus: victim or violator?

This article explores sexual boundary violations and their clinical implications in forensic settings. In particular, the authors consider whether female professional and male patient relationship transgressions have similar clinical meanings as the inverse, or whether there is an inherent or perceived difference between genders. Furthermore, attention is brought to the problematic aspects of reductive, dichotomous interpretations of victim–violator relationships. Composite cases of such clinical "accidents" are presented. These are set within secure environments in the United Kingdom. The scope of these cases encompasses incidents between clinician and patient, as well as inter-professional boundary violations. By discussing these vignettes, the authors demonstrate the risk of a subtle, gradual, and insidious erosion of boundaries, alongside more overt incidents of a sexual nature and abuse of power. Contemporary societal factors that may influence conscious and unconscious biases will also be considered in the post #MeToo world. Where clinical examples are given, they are composites of cases reported in the public domain known to the authors. They are clinically accurate but do not involve actual identifiable people and cases.

Responding to Sexual Boundary Notifications: The Evolving Regulatory Approach in Australia

ABSTRACT A sexual boundary violation by a health practitioner has an immense impact on a patient, and the trust and confidence in the health care system and the health care regulator are negatively affected. The Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia (MBA) in 2017 commissioned an independent review in response to a specific high-profile case of multiple physician-patient* sexual boundary violations. In response to recommendations for process improvement, Ahpra and the MBA worked to transform the regulatory management of sexual boundary notifications.The purpose of this paper is to explore the structural and cultural changes that have been made to manage sexual boundary violation notifications and lessons learned through the process. Three factors — specialized decision-making, training for investigators and policy and cultural changes — were identified as key elements of the change process. Since the changes in 2017, the rate of immediate regulatory action taken in response to sexual boundary notifications has increased substantially, with a higher proportion of decisions resulting in suspension of a physician’s registration. Further work on the experience of those who are part of the notification process and supporting people to share their stories and experiences through the notification and tribunal process is ongoing.