Physician Health Matters

Maintaining Professional Boundaries

Physicians must be aware of the importance of maintaining professional boundaries with patients and colleagues throughout their medical careers. Without constant vigilance, physicians may find themselves sliding down a slippery slope of inappropriate personal interactions that can lead to “boundary crossing.” Intentional or inadvertent overstepping can result in serious misunderstandings, disciplinary action by employers, sanctions by the Board of Registration in Medicine (BRM), and damage to the physician’s personal life and professional career.

Managing Workplace Conflict: Improving Personal Effectiveness December 14 & 15, 2006 MMS Headquarters, Waltham Faculty: Charles Swearingen, M.D. / Ronald Schouten, M.D., J.D. Luis T. Sanchez, M.D. / Diana Barnes Blood, M.S.W., L.I.C.S.W. Looking to prevent and resolve conflict in the medical workplace? Learn improved methods of relating with peers, co-workers, and patients through interactive lectures, demonstrations, and role-playing in a confidential setting. Jointly sponsored by the MMS and Physician Health Services, Inc. CME Credit: Earn up to 12.75 AMA PRA Category 1 Credits™ (RM) To register, call (800) 843-6356 or visit www.massmed.org/cme.

The BRM and most hospitals and other health care organizations have rigorous expectations regarding appropriate professional boundaries for physicians. In addition, the AMA’s Code of Ethics, www.ama-assn.org (look under the “Professional Resources” section), provides some guidance for physicians.

Here are some examples that could constitute improper boundary violations or create a slippery slope toward such violations:

• Accepting money, loans, or gifts from patients or staff
• Setting up private financial arrangements to pay for services or care
• Providing patient care in social settings or in locations other than the typical professional setting
• Utilizing a practice or place of work for personal financial gain (creating a conflict of interest)
• Promoting personal business ventures with patients, colleagues, or staff
• Yelling at nurses or co-workers or using any type of physical force or violence

When making ethical decisions regarding employment and social relationships with patients, colleagues, and staff, remember that there is an inherent power discrepancy between the physician and patient and between the physician and other health care staff. Respecting that discrepancy can help avoid exploitation, whether intentional or inadvertent.

For example, a physician should carefully consider whether to disclose personal information to patients. Patients may perceive physician disclosures that are unrelated to patient care -- such as personal comments, questions, or even casual jokes intended to put a patient at ease -- as inappropriate, intrusive, or offensive.

Physicians must also be careful to maintain professional boundaries on a sexual level to avoid allegations of sexual harassment and misconduct. The personal space of patients or other office staff should be respected at all times. Policies for using chaperones should be considered, adopted, and consistently implemented.

Physicians may become increasingly susceptible to boundary violations when they are under stress. Professional boundaries are more likely to be compromised in an intense work environment where physicians are feeling pressure, anxiety, tension, and strain. Physician Health Services, in conjunction with the MMS, is holding its fourth course on “Managing Workplace Conflict: Improving Personal Effectiveness” on December 14 and 15 (see box). This two-day course can help physicians identify acceptable professional boundaries and provide them with tools to help maintain those boundaries amid stressful situations.

For more information, contact PHS at (781) 434-7404 or visit www.physicianhealth.org.

– Jessica Vautour
– Linda Bresnahan