Boundary breach: compromising compassion

26 November 2018 | Harry McCay, BComm, LLB, Senior Solicitor, Avant Law, ACT

Sometimes patients’ health issues can in part arise from their personal circumstances, for example being unemployed or in an abusive relationship. These patients can be emotionally trying for doctors as proper treatment is difficult to achieve without addressing or eliminating the situational barriers.

A recent complaint to AHPRA is a cautionary tale, where a member’s compassion to a patient was confused by the patient as a boundary transgression.

A helping hand

The patient visited the doctor as they were experiencing depression after separating from their spouse. The patient was struggling to find a job and was staying at a motel which they said they could soon no longer afford to do.

The doctor felt sorry for the patient and offered that they live in their granny flat, rent free, until they got back on their feet. The patient did not want to accept the offer without making a contribution, so the doctor asked if they would mind cooking the evening meals for them, to which the patient agreed.

The arrangement continued for a number of weeks and during dinner time the doctor and patient would often chat about their families and other personal matters.

The patient then started to see a psychologist about their depression and in one of the sessions, discussed the arrangement. Following the session, the patient formed the view the doctor was taking advantage of them and the relationship had crossed appropriate lines because the doctor had shared personal details with them. Consequently, the patient complained to AHPRA.

AHPRA imposes training requirement

The doctor wrote to AHPRA about the notification and they received a response that the Medical Board was proposing to impose disciplinary action, requiring the doctor to undergo training in patient boundaries.

The doctor contacted us for assistance at this point and a submission was put forward on their behalf which included an acknowledgement they had compromised the doctor-patient relationship and that we would support them by developing a tailored education plan.

In coming to a determination, the Medical Board stated it did not believe the doctor would pose a threat to the public by acting in the same manner again. The Board required the doctor to complete an education course on boundaries and approved the education plan put forward.

Case comment

Dr Kelly Nickels, MBBS (Hons), FRACGP, M Hlth & Med Law, Practice Manager Claims – Non-civil, Avant Medical Defence and Services, VIC

We regularly assist members address patient complaints to a regulatory body about a boundary transgression. Boundary violations, even relatively minor violations such as the case described above, are taken very seriously by our regulatory bodies.

Often doctors don’t realise that an act of kindness on their part, such as giving a patient a lift home, lending money, making small talk about personal circumstances or conducting a consultation outside of normal surgery hours, can be easily misconstrued by a patient or other observers.

In showing compassion to a patient, it is important to remember the boundaries of a doctor-patient relationship and carefully consider whether a particular action will cross or blur the boundary.

If you are unsure whether your compassion may be crossing the line, you may wish to speak with a colleague, or contact our Medico-legal Advisory Service on 1800 128 268 for expert advice, available 24/7 in emergencies.

More information

Read our article ‘Crossing patient boundaries’.

Download our factsheet, ‘Unhealthy relationships with patients’.

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