Can an unnecessary intimate examination by a doctor be ‘sexual misconduct’ if there is no sexual motivation?
The allegations about doctors who worked for Mohamed Al Fayed raise broader questions about how we define sexual misconduct in healthcare, and whether a health professional's motivation should matter.
First published on Substack, Sep 30, 2026
‘Sexual misconduct’ is a term used by the General Medical Council (GMC) to encompass a wide range of sexual behaviours that can raise concerns about a doctor’s fitness to practise. It encompasses behaviours that present very differently, including rape, accessing or possessing child sexual abuse material, voyeurism, sexualised comments, entering into an ongoing ‘relationship’ with a patient...and so on.
There are issues with lumping together such different types of behaviours, especially when it comes to identifying and preventing them. Understanding these behaviours in detail, how they manifest and the factors involved, is essential for designing effective interventions.
At Opening Up, I have been analysing fitness-to-practise data. As part of that, I have been working on breaking down ‘sexual misconduct’ behaviours into a more useful, evidence-based taxonomy, which I’ll write about in detail in a future post. Through this work, I have become concerned that too much weight is sometimes placed on sexual motivation when assessing sexual misconduct. Sexual misconduct isn’t always sexually motivated, and sexual motivation is difficult to prove. Focusing on motivation centres the perpetrator’s intentions and internal state, rather than the experience of the patient-survivor.
Unnecessary or inappropriate intimate examinations are one way in which sexual misconduct occurs in healthcare settings. This particular form of abuse can be incredibly difficult to identify because patients don’t always know what is and isn’t medically necessary, or how an examination should be performed.
The allegations and GMC investigation
Mohamed Al Fayed (the former owner of Harrods who died in 2023) has been accused by numerous women of rape and sexual assault.
Some women have alleged that they were subjected to gynaecological examinations and sexual health testing by doctors in connection with their employment at Harrods. They also allege that sexual health information was shared with Al Fayed.
The GMC is investigating doctors in connection with these allegations, and it has placed interim restrictions on two doctors’ practice while its investigations continue. Interim restrictions are not findings, and no allegations against any doctor have been proven. Survivors have criticised the GMC for not investigating concerns earlier.
I cannot comment on these specific cases, but they raise important wider questions about how sexual misconduct gets defined and regulated.
Does sexual motivation matter?
The allegations involving doctors in the Al Fayed case raise the possibility of a complex scenario that could arise in healthcare settings: an intimate examination carried out at the request of a third party. If a doctor were to perform a clinically unjustified intimate examination on a patient at the request of somebody else, would that be sexual misconduct? Might it still be sexual misconduct even if the doctor wasn’t themselves sexually motivated? And how should regulators approach cases where a doctor’s professional role or access to confidential information is alleged to have facilitated abuse by somebody else?
If an intimate examination has no clinical justification and no benefit to the patient, the absence of sexual motivation on the doctor’s part doesn’t change the fact that the patient has been subjected to an unjustified violation of their bodily autonomy.
Why the label matters
Classifying an unnecessary or inappropriate intimate examination as sexual misconduct can matter even where there is no sexual motivation:
It can affect how the seriousness of the conduct is understood and, potentially, the sanction imposed. It means the conduct is not treated as ‘just’ a consent or confidentiality issue, but recognised as an intimate violation.
It determines how cases are recorded. Those data can help regulators and researchers better understand patterns and design interventions to identify abuse and protect patients.
Most importantly, the label can help patient-survivors recognise and make sense of what happened to them. Naming the conduct as sexual misconduct can validate the seriousness of their experience and may help survivors identify it as something that can be reported.
That doesn’t mean motivation is unimportant to examine, but it shouldn’t be the basis for deciding whether an act is sexual misconduct.
The patient-centred gap
The experiences of patient-survivors should be central to how we understand and define what constitutes ‘sexual misconduct’. Yet very little research has been done with patient-survivors, or patients more generally, to understand their perspectives.
This matters because patients may experience and understand these behaviours differently from the regulators responsible for defining, categorising and investigating them. Without understanding the patient perspective, we cannot design effective interventions to protect patients or support them to recognise and report abuse.
Cases involving intimate examinations illustrate this problem. Patients can experience a clinically unjustified intimate examination as a violating and abusive experience, regardless of the professional's motivation.
Until our definitions of sexual misconduct are shaped by patients’ own experiences and understanding, we risk failing to recognise serious abuses of power and trust.
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Joni Browne, Founder at Opening Up
