Home › Professional Boundaries - Maintaining Healthy Professional Boundaries

HOME PREVIOUS SECTION NEXT SECTION

 

THE SKILLS FOR ESTABLISHING AND MAINTAINING HEALTHY PROFESSIONAL BOUNDARIES

To be able to establish and manage professional boundaries requires doctors to continuously develop a range of skills over your career; this is important because the roles of healthcare professionals and their working contexts will change throughout a career. Effective learning about boundaries involves a blend of developing a range of practical tools and learning new ways of being. There is an interconnectedness between the skills required and we will focus on three of them.

 

Reflection

Reflection is an important skill for doctors; by reflecting on your experiences- both positive and negative - you can help you develop new insights and improve your clinical practice.  Reflective practice has been defined as:

the process whereby an individual thinks analytically about anything relating to their professional practice with the intention of gaining insight and using the lessons learned to maintain good practice or make improvements where possible

The potential for reflection to develop and improve practice means that it is an important part of medical appraisals, reviews of progress and revalidation a key skill.

There are a wide range of resources available to doctors to support reflective practice:

 

Self-awareness

Self-awareness has a strong connection with reflection. It refers to an individual's tendency to pay attention to his or her own emotions, attitudes, and behaviour in response to specific situations. With regard to doctors, self-awareness is about their insight into how their emotional makeup influences patient care. Being aware of the impact you might have on situations, on your colleagues and on patients is an important professional skill. Setting a time to regularly think about the contribution you make – whether things go well or not well – can be help make you a more effective doctor and a good colleague.   Have you ever been rude to the referring GP or A&E doctor? Has someone tested your patience in theatre today? Were you short with the clinic staff because you were overbooked? We often think about clinical cases when we go home, but how often do we think about how our actions affected others? Self-awareness is the ability to conduct oneself as a reflective and professional and includes seeking feedback, valuing it, reflecting and responding to it appropriately.

 

Self-care and stress management

Working as a doctor can be very stressful and stressed practitioners can unintentionally cross professional boundaries in an effort to treat patients quickly and efficiently. At times, the atmosphere and culture in your workplace might not be positive or supportive.  Thinking proactively about how you can support yourself and build up your resilience can be useful

Here is a simple set of guidance developed for medical staff by the Deans of Yale and ICAHN School of Medicine in the United States which suggests some very practical steps:

  1. Develop a core set of beliefs that nothing can shake. (e.g. you will not tell lies, not bully staff, not cover up patient safety issues).
  2. State your beliefs openly and often when challenged.
  3. Try to find meaning in whatever stressful or traumatic thing has happened.
  4. Try to maintain a positive outlook.
  5. Take cues from someone who is especially resilient. (e.g. informal or formal peer supporters)
  6. Don’t run from things that scare you: Face them.
  7. Be quick to reach out for support when things go haywire.
  8. Learn new things as often as you can.
  9. Find an exercise programme you’ll stick to.
  10. Don’t beat yourself up or dwell on the past.
  11. Recognise what makes you uniquely strong – and own it.

 

There is a range of people and resources that are ready to help you manage your stress at such times. Your educational supervisor and training programme manager are obvious first points of contact. Alternatively, Health Education England has a range of regional support available to you including coaching and career support. Both the GMC and the BMA offer a range of support services, too:

https://www.gmc-uk.org/concerns/information-for-doctors-under-investigation/support-for-doctors/managing-your-health/support-resources

 

We Don’t Need Self-Care; We Need Boundaries

In an interesting advisory article, a psychiatrist questions the notions of self-care and resilience and advocates strong boundaries to promote individual well-being.

https://opmed.doximity.com/articles/we-don-t-need-self-care-we-need-boundaries?_csrf_attempted=yes