The blurring of professional boundaries between physicians and patients is not simply an ethical issue. It's a threat to a physician's reputation, license, and livelihood...not to mention the liability risk.
Some boundary violations are obvious, such as pursuing an intimate relationship with a patient or with a member of the patient's family. Others are not so clear. Knowing where to draw the line can be difficult, a balancing act between maintaining professional distance and building a warm, caring doctor-patient relationship.
"Doctors are divided on how strict the boundaries should be. Some have firm rules against socializing with patients or revealing personal details about their own lives. Others say a closer relationship can build trust and make it more likely patients will follow medical advice," (The Wall Street Journal, December 8, 2015). Wayne J. Riley, president of the American College of Physicians, says doctors should "adopt a posture of warm detachment" with their patients.
Defining what is and what is not a boundary violation can be a dilemma. Do you have a dual relationship -- professional and social -- with some patients? Do you share your personal problems with patients? Be careful.
Here are a few other warning signs that can be interpreted as possible boundary violations:
- Accepting inappropriate or expensive gifts from patients.
- Addressing patients with terms of endearment such as "dear" or "darling."
- Seeking social contact with patients or their family members outside the professional relationship.
- Calling in prescriptions for social acquaintances.
- Spending more time with patients you find physically attractive or socially "important."
Doctors must be especially cautious in social media exchanges with patients. In 2013, the Federation of State Medical Boards and the American College of Physicians issued this policy statement: "Doctors should not 'friend' or contact patients through social media," nor should they send text messages "for medical interactions with even established patients except with extreme caution and patient consent."
Another warning: Watch the name-dropping. Under HIPAA rules, "If a doctor sees a patient in a public setting, the physician isn't supposed to acknowledge that the person is a patient---unless the patient reveals the relationship first," (The Wall Street Journal, December 8, 2015).
A few suggestions:
- Treat all patients equally.
- Document inappropriate advances from patients.
- Never date patients or end a professional relationship to pursue a personal relationship.
- Never ask a patient for professional advice during a clinical encounter.
- Respectfully decline expensive gifts from patients.
- Always ensure a patient's comfort and privacy during a procedure or exam.
The bottom line: The doctor-patient relationship is built on mutual respect and trust. Violations of professional boundaries---both the obvious and not so obvious---are not only a threat to the doctor-patient relationship, but to one's ability to provide the objective, compassionate care patients deserve.
Ken Teufel, M.D., M.A.