Professional Boudaries The Doctor Patient Relationship

Introduction

The doctor patient relationship is a professional one. It is governed by a framework which enables the physician to gain the patient’s confidence and to occupy a place in the patient’s life as a provider of health and healing.  Some of the attributes of this relationship, such as confidentiality and respect for patient autonomy, are well discussed and carefully established in each professional encounter.  Less often discussed, however, are topics such as friendship, affection, love, and sexuality. These very personal, and very human realities have the potential to enhance the doctor-patient relationship and lead to greater esteem and healing. They also have the potential to lead to breaches of trust and great harm for both doctor and patient. In this unit we will discuss how physicians can develop a capacity for relationships with patients that allow both to experience the humanity of medicine.

Objectives

In this unit you will:

  1. Learn the ethical and professional principles which guide the doctor patient relationship.
  2. Acquire skill in analyzing various professional dilemmas involving intimate relationships, conflicts of interest, and relational boundaries.
  3. Practice communicating these boundaries to patient and families in a professional and compassionate manner.

Preparation

  1. Read the required articles on the resources page.
  2. Read the scenarios on the cases page.
  3. Suggestions for written work:
    • Choose one of the cases for the week.  Make an outline list of the professional issues raised by the case. Then write one paragraph each explaining what you see as the opportunities and the dangers involved in the case.
    • Review one of the articles for the week.
    • You could read and write a review of Desire to Heal (a chapter in a book of the same name by physician / author Rafael Campos.
    • Presuming that one of the cases for this week ends up in Newsday, write a letter to the editor.

Process

  1. Class begins in Lecture with a brief presentation by Dr. Vetrano and Dr. Ells, and an opportunity to vote on some of the cases.
  2. In section continue to discuss the cases and readings.
  3. Discuss with one another and with section faculty what strategies one might use to explain professional boundaries to patients.
  4. In this area of medicine the role of intuition is especially valuable. It will be helpful to have section participants disclose their first reaction to the cases and then attempt to explain their reactions.
  5. Role play may be especially helpful today. Feel free also to vary the details of the cases to see how this might impact the group’s evaluation.

Study Guide

  1. Explain the role of power, consent, and professional frame keeping in the doctor-patient relationship.
  2. What are the consequences of professional misconduct in the doctor patient relationship?
  3. What steps can doctors take to insure that professional boundaries are maintained?
  4. See individual questions for each case scenario.