Maintaining Boundaries: Top 10 Tips

1. RECOGNIZE THE RELATIONSHIP

There is a clear imbalance of power between a physician and a patient. The patient exposes himself or herself and is highly vulnerable. No matter what the patient says or does, a physician will be held to higher expectations. The physician must at all times place a patient's welfare above self-interest.

2. INTIMACY WITH PATIENTS

No physician should have sexual or intimate relations with patients. This standard should also be applied to family members of patients (spouse, child, parent), especially if they have decision-making authority for the patient. A physician cannot use or exploit the trust, knowledge, emotions, or influence derived from the relationship.

3. DO NOT ENGAGE IN OTHER INAPPROPRIATE BEHAVIOR

Some actions or verbal statements fall short of sex but still are sexual in nature and have no diagnostic or therapeutic purpose. A physician should also refrain from sexually inappropriate comments and flirtatious banter.

4. CONSIDER HAVING A CHAPERONE

Physicians should minimize the risk of allegations of inappropriate behavior. Although a chaperone is not typically required, a physician should consider one for the examination of minors (in addition to a parent) and gynecological or pelvic examinations.

5. DO NOT USE A PATIENT FOR YOUR FINANCIAL BENEFIT

This behavior erodes the relationship of trust necessary to a physician and a patient. Aside from the obvious examples, beware of more subtle examples like the dual relationships, gifts, and obtained fundraising (see below). Avoid anything that allows profit to be made from a physician’s connection with or the information received from a patient.

6. DUAL RELATIONSHIPS

Should a physician use a patient as a banker or contractor? The safest route would be to decline. But if the physician proceeds, a physician must be sure that the behavior is objectively fair, reasonable, and beyond reproach. A quid pro quo could imply preferential treatment or call into question a physician's objectivity.

7. ACCEPTING GIFTS

Acceptance of gifts from patients may be appropriate if it is an expression of appreciation or a reflection of a cultural tradition and it is modest. Such a gift should never influence the medical care rendered. Gifts that are given for inappropriate purposes such as to secure preferential treatment or to gain inappropriate attention should be avoided.

8. FUNDRAISING

Many physicians are active in fundraising for good causes, but protecting the integrity of the physician-patient relationship takes precedence over altruism. A physician should not directly solicit patient at the time of clinical encounter, and should make sure that donations are fully voluntary.

9. SOCIAL NETWORKING

Facebook, LinkedIn, and Twitter may cause the boundaries between physician and patient to blur. These sites can enhance physician-patient trust and communication. However, the problem of crossing boundaries remains, and the Internet is a very public venue.

10. BEFORE ACTING, OBJECTIVELY ASK

Would engaging in this activity compromise the relationship with this patient or a physician’s ability to render medical care? Would it cause others to question ethics or professional objectivity? Would the physician be uncomfortable if the behavior was disclosed to a colleague or in public?