Dialogue Volume 15, Issue 2 2019 - Page 26

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