Professional boundaries are an essential component of the physician and patient relationship. A physician must adhere to appropriate standards of conduct with patients at all times. Potential professional conduct violations by physicians include behavioral, physical, communications and abuse of power. It is imperative that physicians establish and preserve appropriate professional boundaries to protect themselves both legally and professionally.
Consider the following fictionalized vignette:
Leah (a patient) is both a friend and patient of Bonnie (a doctor). Bonnie practices in a small rural community. Bonnie and Leah regularly see each other socially. Bonnie has been treating Leah for diabetes and has advised Leah to limit and monitor her carbohydrate intake including sugary desserts. Leah is also on medication that should not be combined with alcohol. Both Bonnie and Leah have social media accounts on Facebook. One day, Bonnie sees a photo Leah posted on Facebook of Leah eating a candy bar holding a beer.
What professional boundaries is Bonnie at risk of violating? How should Bonnie proceed? The above example underlines the complexities of maintaining proper boundaries as a physician.
What is a professional boundary?
Professional boundaries define appropriate standards of behavior between professionals and the public. Power imbalances often exist within a professional relationship, and boundaries serve to protect both the public and professional.
The physician/patient relationship is inherently unequal. A physician holds a unique position of authority. While connecting with patients and building rapport are essential components to the doctor/patient relationship, this relationship must be developed without crossing professional, ethical and/or legal boundaries. A physician must maintain appropriate standards of conduct with patients at all times.
What is a boundary violation?
A boundary violation involves any behavior or interaction which causes harm to the professional or public. The physician/patient relationship involves trust and respect. If this trust or respect is exploited or abused, through either sexual or non-sexual misconduct, a boundary violation has occurred.
What are potential boundary violations between physicians and patients?
- Technology (social media) violations: Initiating communication with patients on social media, posting inappropriate or sexually explicit content on one’s personal social media.
- Emotional violations: Showing favoritism toward a patient, mismanaging feelings of frustration toward a patient.
- Physical violations: Inappropriate physical contact between physician and patient such as a long hug behind closed office doors.
- Relationship violations: Engaging in a romantic or sexual relationship with a current or former patient, flirting with a patient, treating a friend or family member, inviting a patient to the physician’s home.
- Power violations: Using a patient’s personal connections for personal gain, abusing a physician’s position of authority to harm or exploit a patient.
- Communication violations: Talking with a patient about inappropriate subject matters, sharing personal information with a patient that does not benefit the patient’s well-being, failing to refer a patient to a counselor as needed.
While many of the above examples are clear boundary violations, others are not so clear cut and may begin with a physician’s best intentions. Consider a physician who treats a family member who otherwise could not afford treatment, a doctor who innocently accepts a patient’s Facebook friend request, or a physician who gives an ailing patient a long hug behind closed office doors. Physicians must learn to recognize potential boundary breaches and should regularly consult with their supervisor to minimize the risk of boundary violations.
How does a physician maintain appropriate professional boundaries?
Physicians have a unique position of authority, trust, and influence. All behaviors and interactions between a physician and patient should prioritize the well-being of patients. A physician’s focus should be on meeting the needs of the patient rather than their own needs. Physicians must be vigilant in considering the implications or consequences of their behavior.
Examples of physicians at risk for boundary violations:
- New physicians: Potential boundary violations may be more difficult to recognize for those newer to the profession. Newer physicians should regularly consult with their supervisor to minimize the risk of boundary violations.
- Similarly-aged physicians/patients: Physicians of similar age to patients can mistakenly develop a peer relationship based on common interests or hobbies. A physician is not a friend, parent, or teacher.
- Small towns or rural settings: Physicians who work in a small town may see their patients frequently outside of the office. Physicians should devise a plan as to how such encounters will be handled in order to minimize potential boundary issues.
- Dual relationships: Some physicians may hold dual relationships with patients. A physician may choose to treat friends or family. Dual relationships can be messy, and vigilance is required to avoid boundary violations.
- Physician’s social/emotional health: Physicians who are undergoing difficult personal circumstances such as grief, loss, divorce, or mental health issues can be at greater risk for blurred boundaries.
Questions physicians should ask themselves:
- Do I treat any particular patient differently than other patients?
- What is my social media policy related to my patients?
- Do I have any inappropriate content on my personal social media accounts?
- Would I behave differently with my patient if I was in the presence of my supervisor?
- Do I dress or act differently when I know that I will see a particular patient?
- Has a colleague ever questioned my behavior toward a patient?
- Would I have concern about another physician behaving as I do?
- Do I ever put my own well-being above that of my patients?
- Am I currently having any personal difficulties that could affect my professional judgement?
- Do I regularly consult with my supervisor about potential boundary risks?
- Am I following the standards of conduct expected by my licensing board?
If you are a physician facing disciplinary action, it is imperative to enlist the assistance of an experienced licensing attorney at the earliest stage of the disciplinary process. The Law Offices of Lucy S. McAllister are here to help. We understand the unique legal complexities facing physicians. We have the knowledge and experience to craft a comprehensive strategy and are dedicated to navigating your specific case through the disciplinary process to best defend your professional interests.
The Law Offices of Lucy S. McAllister have successfully represented a wide range of California licensed professionals including physicians, nurses, educators, and mental health practitioners. We are experienced in handling all types of licensing issues. Let us help you protect your professional license, your reputation, and your livelihood.
For additional information or to schedule a consultation on a professional licensing issue, please contact us today at (877) 280-9944.
For Additional Information
The New Boundaries Between Doctors and Patients, Wall Street Journal
Crumbling Boundaries Between Patients and Doctors