PHYSICIAN HEALTH MATTERS
Professional Boundary Considerations for Physicians
Vital Signs: Summer 2010
When it comes to professional boundaries, doctors are probably held
to a higher standard than other professionals. This is largely because
of the significant “power differential” between physicians
and patients. Physicians have the knowledge and capacity to diagnose,
support, and treat, while patients rely upon the physician to bring them
relief in vulnerable moments.
A patient’s reliance on a physician for bodily well-being
creates a unique dynamic. The doctor’s license to ask intimate
questions, to learn about a patient’s habits, and even to touch
the patient makes it incumbent upon the physician to protect this
trusted relationship in all interactions with the patient.
Even when a patient has similar education, employment status, or
social interests as the doctor, the power differential remains.
Professional boundaries between physicians and patients extend beyond
predatory behavior or sexual interactions. Boundaries must be considered
in any interaction where a physician might be perceived to have personal
interests that conflict with those of the patient or where a
physician’s actions might fall outside the realm of behavior that
would instill public confidence in the physician.
For example, a physician may determine in the course of conversation
that a patient is seeking investment opportunities. The same physician
may need a loan. If the physician borrows money from the patient, even
with the proviso that he or she will pay it back with interest, he or
she is engaging in a transaction that has the appearance of and/or the
capacity for taking advantage of the power disparity. This type of
transaction would constitute a professional boundary violation that
could become the basis for professional discipline.
Likewise, a violation of professional boundaries can occur if a
physician meets with a patient in an unprofessional setting. Even if the
doctor is doing this as a convenience to the patient, there is potential
for such an interaction to be viewed as unprofessional and contrary to
the expected deference that a physician must give to the doctor-patient
relationship. Accordingly, meeting a patient in a coffee shop to provide
medical advice, care, or even a prescription would create professional
boundary concerns.
The Massachusetts Board of Registration in Medicine has repeatedly
disciplined physicians for “conduct that undermines public
confidence in the integrity of the medical profession.” So even if
an interaction is intended to benefit a patient, if the action falls
outside of the scope of the formal doctor-patient relationship, it could
undermine the relationship generally and cast aspersions on the
profession as a whole. Therefore, physicians must always be mindful not
only of how they act with their patients but also of how their actions
could be viewed by others.
Along with the privilege of practicing medicine comes the
responsibility of understanding the influence doctors have over
patients. Maintaining clear, professional boundaries respects the unique
status afforded the medical profession within the community at
large.
For more information, contact Physician Health Services at (781)
434-7404 or visit www.physicianhealth.org.
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