DocCom Module 41: "Boundary Issues"|with everything you need

Questions for Reflection: 1. What elements distinguish a professional relationship from other human relationships such as friendship, family or that between colleagues or classmates? 2. In your professional relationships to date (as clinician or as patient or as family member of a patient,) have you been aware of situations when the professional person responded in ways that did not seem appropriately “professional” (perhaps by behaving in too social or friendly a manner, or perhaps by seeming too distant or abrupt)? How do these experiences inform your sense of “professionalism”? 3. In a clinical situation, what principles might be useful in deciding how to respond to gifts you are offered from patients, or to a possible “come-on” from a patient, or to patients’ questions about your personal life? 4. Have you encountered situations in which your professional boundaries became an issue? How did you decide what actions to take? 5. Personal issues play a role in physician’s behaviors in regard to professional boundaries. How do the following issues apply to you? To what degree do you take responsibility for the happiness and well-being of your patients? Of your family and friends? To what degree are your interactions with patients meeting your own emotional needs? How comfortable are you in saying "no" to patient requests? Are you prone to "rescue fantasies" in your care of patients? Do you often take care of the needs of others before your own? What were the attitudes and behaviors about boundaries in your family of origin? Key Principles: 1. Boundary-challenging interactions are those in which optimal professional action is unclear, often because the distinction between social and professional behavior is hazy. 2. Every physician is confronted with boundary-challenging situations such as gift-giving, selfdisclosure, physical touching, social invitations or social encounters with patients. 3. Problem-solving requires physicians to reflect on the value of altruism, consider patient and physician motives, take into account inherent power differentials, seek consultation, and to err on the side of firm boundaries. 4. Communication about boundaries should convey respect for patients’ feelings as well as acknowledge the complexity of the situation. Consider making statements about ethical and professional standards, statements that clarify the professional nature of clinical relationships and statements that indicate a need for additional time to consider the situation.