When considering a medical practitioner’s fitness to practise where the misconduct consisted of violation of the professional relationship between doctor and patient the efforts made by the practitioner to address his behaviour for the future might carry less weight than in cases where the misconduct consisted of clinical errors or incompetence.

Sales J so held, sitting in the Administrative Court of the Queen’s Bench Division, when dismissing an appeal against a decision of the Fitness to Practise Panel (“FTPP”) of the General Medical Council (“GMC”) that the fitness to practise of the claimant, Dr Cheng Toh Yeong, was impaired by reason of misconduct, pursuant to s 35C(2)(e) of the Medical Act 1983 and a related decision to suspend the claimant’s registration as a medical practitioner for 12 months.

SALES J said that he accepted the GMC’s submission that the types of cases involving misconduct by a doctor in the form of clinical errors and incompetence which were considered in Cohen v General Medical Council [2008] EWHC 581 (Admin), Meadow v General Medical Council [2007] QB 462 and Azzam v General Medical Council [2008] EWHC 2711 (Admin) fell to be distinguished from the principal misconduct in the present case which involved improperly crossing the patient/doctor boundary by entering into a sexual relationship with a patient. The overarching function of the GMC as set out in s 1(1A) of the Medical Act 1983 informed the meaning of impairment of fitness to practise by reason of misconduct in s 35C(2), so that under s 35C(2) and s 35D the FTPP was entitled to have regard to the public interest in the form of maintaining public confidence in the medical profession generally and in the individual medical practitioner when determining whether particular misconduct on the part of that medical practitioner qualified as misconduct which currently impaired the fitness to practise of that practitioner. Where a medical practitioner violated such a fundamental rule governing the doctor/patient relationship as the rule prohibiting a doctor from engaging in a sexual relationship with a patient, his fitness to practise might be impaired if the public was left with the impression that no steps had been taken by the GMC to bring forcibly to his attention the profound unacceptability of his behaviour and the importance of the rule he had violated. The public might then, as a result of his misconduct and the absence of any regulatory action taken in respect of it, not have the confidence in engaging with him which was the necessary foundation of the doctor/patient relationship. Where a FTPP considered that fitness to practise was impaired for such reasons, and that a firm declaration of professional standards so as to promote public confidence in that medical practitioner and the profession generally was required, the efforts made by the practitioner to address his problems and to reduce the risk of recurrence of such misconduct in the future might be of far less significance than in other cases, such as those involving clinical errors or incompetence.