Boundaries (boundary = limit, borderline
) in patient care are “mutually understood, unspoken, physical and emotional limits of the relationship between the trusting patient and the caring physician or provider.” Health professional boundaries are a set of culturally and professionally derived rules for how health professionals and their patients interact. They help to establish and maintain a trusting provider-patient relationship and help clinicians to deal with their patients with justice and equity.
In caring for seriously ill patients, it is common for strong emotional bonds to develop. But, when the limits of the provider-patient/family relationship are not clear or respected, problems can surface.
Usual reasons for boundary problems:
- personality styles or psychiatric disorders
- health professional stress/burnout
- cultural misunderstandings
Warning signs and examples of potential boundary blurring include the following.
- Gift giving from/to patient/family.
- Patients having or wanting access to provider’s home phone number, or other personal information.
- Patient/family expectations that the provider will provide care or socialize outside of clinical care settings.
- Patient/family requests that the provider participate in prayer.
- The health care provider revealing excessive personal information with patient/family.
Not all boundary issues are negative to the provider-patient relationship. However, it is important for the provider to self-reflect when boundaries are approached.
- Am I treating this patient or family differently than I do my other patients?
- What emotions of my own—affecting clinical decision-making—does this patient/family trigger?
- Are my actions truly therapeutic for the patient, or am I proceeding in a way to meet my personal needs?
- Would I be comfortable if this gift/action were known to the public or my colleagues?
- Could this boundary issue represent a sign that I am facing professional burnout?
How to handle boundary alarms.
- Set clear expectations with patients and families as to your role in the context of their care, your availability, and the best ways to communicate with you.
- Address issues as they arise with the patient/family. Acknowledge importance of feelings, emphasize the provider-patient relationship and the importance of maintaining objectivity; emphasize that the rejection of a requested behavior does not imply a lack of caring.
- Seek professional counseling for yourself or the patient/family when boundary issues impact your ability to provide objective, adequate care.
See reference for more information.
Adapted from Barbour LT. Professional-patient boundaries in palliative care. Palliative Care Network of Wisconsin. Fast facts and concepts #172. Internet. Available at https://www.mypcnow.org/fast-fact/professional-patient-boundaries-in-palliative-care/. Accessed on June 20, 2021.