ABOUT PROFESSIONAL BOUNDARIES
Contemporary NHS healthcare practice is dense, complicated and in a permanent state of change and improvement. In order to help all healthcare professionals (HCPs) to function and flourish in this challenging landscape, professional boundaries have evolved. They exist for a number of reasons, for example, they:
- enable the doctor and the patient/family to engage safely and effectively in a therapeutic relationship
- simplify the position of doctors in a complex working environment
- help navigate professional relationships with colleagues
- clarify the professional expectations of doctors
- make clear the limits of our professional roles and therefore help avoid burnout and prevent bullying
During their careers, doctors need to develop the ability to distinguish between professional, therapeutic relationships and social relationships (Peternelj-Taylor and Yonge, 2003, Cooper and Inglehearn 2015). Boundaries may be conceptualised as existing on a spectrum, with safe boundaries at one end, boundary violations at the other, and with a large grey section in between.
Some behaviours e.g. having a sexual relationship with a patient, assaulting a colleague or withholding medication without cause are always unacceptable and represent boundary violations; they are likely to lead to professional criticism and disciplinary action. However, other behaviours are not quite as clear cut - is it ever acceptable to hug a patient / relative? Can you meet an ex-patient socially? Should you accept a social media invitation from a patient? How much should you tell patients about yourself? How do you care for a patient who repels you? Is it OK to have a favourite patient? Should you accept a Facebook invitation from an ex-patient? This module will discuss these dilemmas and the guidance and advice available to you to help you find a way to address these tricky judgements; such situations crop up regularly, you will not be the only doctor to have to think hard about professional boundaries. The good news is that there are multiple sources of guidance and support.
The Medical Defence Union states that:
Instances of doctors allegedly breaching professional boundaries can be headline news and the painful consequences of an investigation can be extremely serious for a doctor, even when the allegations are proved to be unfounded.
It goes on to say that in a recent 10-year period, the MDU opened over 700 advice files relating to medico-legal issues involving professional boundaries. Of these, 30% triggered a GMC investigation https://www.themdu.com/guidance-and-advice/journals/mdu-journal-april-2013/maintaining-professional-boundaries
When we hear the term, the professional boundary the first thought that springs to mind is probably the boundary which exists between a doctor and a patient - and this boundary will be discussed fully next in Section 3. Two other important boundaries –intraprofessional and interprofessional boundaries, that is, the boundaries between doctors and their colleagues - will be discussed in Section 4. Section 5 will address the challenges posed by the use of social media by doctors. In Section 6, highlights the skills that will help you establish and maintain safe professional boundaries. Section 7 will offer you the opportunity to undertake some activities to assess your current professional boundary skills and some suggested learning activities. The module ends with a list of the references cited and recommends sources of information, support and guidance.
The GMC has a range of online resources to develop your knowledge of current ethical guidance ‘Good medical practice in action’ https://www.gmc-uk.org/gmpinaction/index.asp. Throughout the module, you will come across links to pertinent scenarios which demonstrate how the guidance can be put into practice.