POLICY MATTERS
physician-patient relationship. And it is not
advisable to loan a patient money or hire him to
do yard work at your home even if you know he
is facing some difficulties in his life,” she said.
“The challenge is that a lot of us have a huge
need to be helpful, but realistically, you just can’t
maintain objectivity and help a patient sort out
his finances at the same time. Your role is to be
his doctor, not the person who has a solution for
all life’s troubles,” said Dr. Lent, a family physi-
cian, who developed the Boundaries Course at
Western University in 1999 with colleague, Dr.
Joan Bishop.
The primary focus always needs to be on the
doctor-patient relationship and doing every-
thing we can to make sure that relationship is
safe and respectful, she said.
“And if we have other types of relation-
ships with the patient – and we might – the
doctor-patient relationship still has to be the
main focus,” said Dr. Lent. “If you are living
in a small town and your patient is also your
banker or your neighbour,
that is fine. But you do
need to be aware that you
must keep the management
You just need to be
of medical issues within
mindful of separating a medical context. If the
out your professional, banker asks you a question
clinical role from your pertaining to his health
while you are at the bank
role as a member of a discussing your mortgage,
particular community. you can simply say that
you’d prefer to discuss it
with him when you have
his medical chart in front of you. Then you
ask him to make an appointment at your of-
fice,” said Dr. Lent.
In fact, she says there are “dozens of different
scenarios” in which dual relationships can arise
between physicians and their patients. These
include being members of the same tight-knit
ethnic or religious communities or as partici-
26
DIALOGUE ISSUE 2, 2019
pants in shared community activities, such as
playing on the same sport teams or attending
children’s school events. “You just need to be
mindful of separating out your professional,
clinical role from your role as a member of a
particular community,” she said. “If you do that,
you should be fine.”
In fact, the working group hopes that physi-
cians can share, through the consultation, their
tips for being successful at maintaining dual
relationships. The working group will review
the feedback and develop a list of examples/best
practices that will be added to the companion
document – Advice to the Profession: Main-
taining Appropriate Boundaries. So please let
us know what has worked for you and we will
share it with your peers to help them best man-
age dual relationships.
As well as addressing non-sexual boundary
violations, the draft policy proposes to update
the current policy with the following additions:
Prohibiting sexual relations with a patient for
five years after the last patient encounter, where
treatment provided involved psychotherapy
(that was more than minor or insubstantial.)
Defining and clarifying the terms boundary,
boundary violations, patient and sexual abuse
Requiring physicians to explain the indication
for an intimate examination and considering
the patient’s comfort at all times.
Giving patients the option of having a third
party present during an intimate examination,
including bringing their own third party if the
physician does not have one.
Presenting options to the patient if no third
party is available or if there is no agreement
on whom the third party should be and the
examination is non-emergent. MD