Non-sexual boundaries

Some doctor–patient boundaries are established in Good Medical Practice: a code of conduct for doctors in Australia² (the Code), including conflicts of interest, financial and commercial dealings, and research ethics. Other boundaries may be more subtle.

We take a look at some of the common boundary breaches we see in complaints and disciplinary matters, and how you can avoid the pitfalls.

Treating friends, family and staff

This is addressed in the Code, and yet we still see complaints made either by the patient when the therapeutic relationship breaks down, or by a disgruntled third party.

The Code states that doctors should “whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship”.

For the safety of your patients, and to protect yourself medico-legally, you should ensure you keep your personal and professional lives separate.

Recognising when a therapeutic relationship is no longer healthy

This one can sneak up on you. Beware the patient who makes statements like “you are the only person I trust”, “no one else understands me”, or “I don’t know what I would do if you ever stopped being my doctor”. If a patient becomes too dependent on you, it is time to question whether the therapeutic relationship is still healthy.

When advocacy goes too far

Patients often ask doctors to provide medical reports and letters of support. Becoming too involved, too emotive, or too invested in a patient’s court action – whether it be a claim for compensation or a Family Court matter – can actually diminish a valid clinical opinion.

Providing a clear, factual account of the situation is more valuable to the patient in the long run, and you may avoid a complaint or notification for unprofessional behaviour.

Respect your colleagues

You may not always agree with your colleagues, but you should always behave professionally and maintain a level of respect when communicating with or about your colleagues.

A straight talker in a “woke” world

Remember the funny thing you say to put patients at ease? They always laugh – until that one time a patient takes offence and reports you to Ahpra. Best to keep your political views and clever quips for the family BBQ. It is not always possible to know who will be offended, and by what, so keep it professional at all times.

Don’t overshare

Sharing a personal story with a patient might be a fast track to building rapport, but the patient is not there to hear about your family situation or your personal health problems. So try and avoid oversharing.

Reference

1. https://www.medicalboard.gov.au/codes-guidelines-policies/sexual-boundaries-guidelines.aspx

2. https://www.medicalboard.gov.au/codes-guidelines-policies/code-of-conduct.aspx

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