Patient and health practitioner relationship – Managing professional boundaries
The patient and health practitioner relationship is described as ‘a medium in which data is collected, diagnoses, plans are made, compliance is accomplished, and healing, patient activation, and support are provided. (Goold, 1999)’ The relationship between the two consists of a set of boundaries which ensure that the relationship is kept professional without complications and breaches. Bird (2013) describes professional boundaries as ‘parameters that describe the limits of a relationship in which one person entrusts their welfare to another and to whom a fee is paid for the provision of a service.’ Even so, the boundaries set within the patient and health care practitioner can often be violated by either party. When these boundaries are breached, the practitioner’s professional judgement can often be clouded (College of physiotherapists, 2017). This can become a problem as it may affect the overall management of the patient. However, the question that needs to be posed is what happens when the perpetrators are the patients?
There are various situations which pose a risk for boundary violation within the patient – health practitioner relationship. The college of physiotherapists in Ontario (2017) lists these as, personal disclosure by the physiotherapist, giving or receiving gifts from the patient, engaging in business or leisure activities with a patient and most frequently, comments, words or gestures that are not directly related to clinical care. Practitioners know that they must be professional and respectful to patients as it is protocol however, this is not the same with patients as there is no corresponding rubric for them. The patient’s unwelcome actions towards a practitioner often goes unnoticed and discarded Paturel (2017) . A study by Patural (2017) suggests that often there are physiological explanations for patients who act inappropriately therefore, reporting the patient’s behaviour may not assist in any way.
Comments, words and gestures are most common in a clinical setting as suggested by the college of physiotherapist in Ontario (2017). I have experienced this several times when I treat patients. One particular situation was with a 32-year-old male patient I was assigned to. I successfully conducted my subjective interview and found that we spoke the same language, namely Setswana which, made him comfortable. He immediately trusted me and was co- operative throughout the initial session. However, in the second session this patient kept asking me personal questions. These questions included; where I stay, who I stay with, what time I knock off and where I’m originally from.
The questioning made me uncomfortable and not only did it do that, but what exactly contributed to my uneasiness was the fact that, the patient kept looking at me in an inappropriate manner. When asked why he did so, he mentioned that he was interested getting to know me and wanted to ensure that he remembered my name as his intentions would be to later take me back to Lesotho when he is discharged. Aravind (2017) mentions that health practitioners sometimes reveal increasingly personal details to patients and end up violating appropriate boundaries. Unlike regular social conversation, when addressing patients, the practitioner’s main task should be to listen, not to talk. I found myself failing to do the latter. However, I managed to stop the patient from acquiring a lot of information about me and diverted the questions back to him.
A similar situation was experienced by a colleague of mine with several male patients at once. My colleague had been assigned a patient who was situated in a male ward. When assessing the patient, her patient kept making remarks about her to other patients who were in the same room. She could not fully understand what he was saying as he spoke in a Xhosa but could pick up a few words and some gestures he made. She concluded that they were actually making inappropriate sexual remarks about her and her race. The patient’s remarks made her very uncomfortable thus, resulting in ineffectively managing the patient. She, like many others did not report this incident but ‘went on with her life’. When telling me about this situation, she mentioned that she felt very uncomfortable around the group of patients but would ignore the remarks and continue to treat this patient till he is discharged.
Health insights (2017) mentions that in the course of providing health care services to patients, health professionals are likely to encounter patients who behave in an inappropriate manner. It also states that it is vital for this behaviour to be addressed and this can be done through developing a professional approach which includes, what a healthcare practitioner should do when the line has been crossed; firstly, the health practitioner can find out the motive behind the patient’s actions, secondly; being firm in the face of unacceptable behaviour. That is, reminding the patient of the boundaries set as well as, the role of the healthcare professional as compared to the patients’ role. Thirdly, involving colleagues to ensure safety and lastly, if a patient has assaulted a professional (emotionally, physically, sexually) the first thing not to do is ignore it and pretend it did not happen. The healthcare professional should report the incident and the patient should be dealt with accordingly.
The healthcare professionals’ duty is to ensure that the patients’ needs are met first. A healthcare professional is taught to respect the patient and focus on the needs of the patient as well as providing the highest quality assistance (Holt, 2017). However, the provision of quality healthcare may be hindered because of the violation of the boundaries in the patient – practitioner relationship. Moreover, Inappropriate patient behaviour is unfortunate but inevitable and therefore, it is crucial to ensure that the boundaries set within the patient – practitioner relationship are known by both parties. Thus, diminishing the risk of violating the boundaries set.
References
Aravind.V.K (2012). ‘Boundary Crossings and Violations in Clinical Settings’ Journal psychol med. 34(1): 21–24. Received September 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361837/
Bird, S (2013). ‘Managing professional boundaries’ Reprinted from Australian Family Physician Vol. 42, No. 9. Received September 2019 from https://www.racgp.org.au/download/Documents/AFP/2013/Sep/201309bird.pdf
College of physiotherapists in Ontario (2017). ‘Boundaries and Sexual Abuse Standard’ received September 2019 from https://www.collegept.org/rules-and-resources/new-boundaries-and-sexual-abuse
Goold S, D & Lipkin, M (1999). ‘The doctor – patient relationship – challenge, opportunities and strategies’ J internal medicine, vol: 14 received September 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496871/#b1
Health insights (2017). ‘How to deal with inappropriate patients’ health times received September 2019 from https://healthtimes.com.au/hub/workplace-conditions/60/practice/healthinsights/how-to-deal-with-inappropriate-patients/2228/
Holt, M (2017). ‘Professional Behaviour Activities for Health Care Providers’ received 2019 from https://bizfluent.com/list-6913561-professional-activities-health-care-providers.html
Paturel, A. (2017). ‘When the perpetrators are the patients’ received September 2019 from https://news.aamc.org/diversity/article/when-perpetrators-are-patients/
2 thoughts on “When not to cross that line”
Hi Lindi
Thank you very much for your piece of writing. I think it is a very well written piece on a subject I think many people, especially females, can relate to in our class. Therefore, I think it is good that you wrote about this as it may allow other students to open up more about it if they were victims of this type of abuse.
I think you started off very well, giving a nice introduction and background on the patient/practitioner relationship. You provided a lot of literature with it which is great.
You then gave a good information on what the literature says about how we as practitioners must stay professional but how patients often get away with being inappropriate. This gives the reader a good understanding of how difficult it can be for us as we can be held responsible for small things while patients can get away with a lot.
I like the fact that you used examples of what had happened to you, as well as your colleague. However, I feel the paragraph on the example on what happened to your colleague isn’t a fitting end to your piece. I feel like maybe you still need to add a concluding paragraph after that. or maybe add a paragraph on what the literature says you should do in when something like this happens to you or a colleague.
However, I think you are o the right track. Good work.
Hello Lindi.
Thank you for sharing your piece.
Your introduction was very good. It gave good literature on the topic you are addressing and how one should deal with it. The topic you chose is very relatable. And I’m sure that each of us have been faced with an uncomfortable situation. Where we felt there was nothing we could do. As health professionals in the making we are encouraged to remain professional and respectful to. Our patients, however sometimes it is not always easy. I think you were very brave to share this piece as it is not an easy topic or situation to talk about, especially online. Well done for that.
The way you handled the situation was also good, you put your needs and feelings aside and done what was best for the patient, and I can only imagine how difficult that must have been.
Your content was very good it had good literature as well as your thoughts and feelings. You explained the story very well. Perhaps you could add a bit more on how you felt and how you overcame those feelings.
Grammar and spelling.
Your piece was an easy read with few grammatical errors. I have highlighted the few that I have notices. Your flow was very good and was easy to follow.
Argument.
Your argument was well written, I understood the point you were trying to get across and then you backed it up well with literature. I like how you have your thoughts and then counter argued it with literature stating why you could not do what you had to or wanted to do.. I also liked how you brought to light what you thought you may have done wrong with what literature has said. It just shows that we sometimes do not know how to handle situations and often victimize our selves for the good of others.
References.
Your references were relevant and well incorporated in your piece.
Conclusion
In your conclusion I commend you for adding real life experiences of others that you took the effort to find out how others felt about the situation or experience. However I feel your conclusion Is not very well written. Something is missing, perhaps you could add a nice closing sentence as I feel it is hanging a bit. The piece is very good and needs a powerful ending.
I Hope my comments are helpful. All the best for the final submission
Your piece was an easy read, very relevant and also informative. T