Boundaries create a therapeutic distance between physician and patient and clarify their respective roles and expectations. Boundaries define limits of the therapeutic relationship.
Most boundary determinations are seen daily in clinical practices. Physicians need to exercise judgement and apply ethical principles to manage the outcome of every such case.
Maintaining boundaries do not stop at the office or clinic setting. A patient may recognize you in a shopping mall and hug you or may send an expensive pen as an apology for his/her previous behavior. Or, the physician may be sitting on a bar stool at a local restaurant and his/her patient appears beside him/her and asks to buy him/her drink. What does one do in such a scenario?
Boundary violations of a sexual or financial nature will involve an ethics committee, attorneys, licensing boards, or ultimately, judge and jury. Physicians are responsible for making decisions in their patient’s best interest at all times.
Clinicians must consider the vulnerabilities and risk factors and do what they can to increase accountability. This book is an attempt to help explain important prevention measures for such cases.
The adult who has never learned to say “no” becomes the doctor who is more interested in pleasing his/her patients, than using sound clinical judgment. The adolescent who has learned to manipulate others for his/her own end, can become the predatory physician who misuses his/her power over vulnerable patients.
Many physicians learn the wrong lessons on the job. Even the most well-adjusted professional, with a mature grasp of personal boundaries, does not enter the profession with a clear understanding of professional boundaries. The responsible physician must learn these unique boundaries sooner rather than later. It is difficult to learn the importance of establishing and respecting boundaries when those around you often disregard them, without any disciplinary actions.
Boundary violations do not just happen. They often begin slowly, and progress slowly enough to avoid detection—and then, it is too late. A physician may fantasize about a patient, and when no action has been taken, or no harm done, he/she remains within his/her sphere as this is not a violation. However, this behavior may drift to dangerous territories of violation. A physician must avoid these mine fields, as a license to practice medicine is not an entitlement. License to practice medicine is only a privilege which physicians are trusted with and should always treasure and protect.
