Setting and maintaining doctor-patient relationship boundaries

Posted by dashboard at April 16, 2020 2:39 pm Blog
Setting and maintaining doctor-patient relationship boundaries


Doctors are people too, but the social relationships that other professions build over the course of their careers may not be suitable for doctors and their patients.

Here, we outline what is expected and what is appropriate (and inappropriate) for a doctor and their patients.

Social media

It can seem impossible for some to imagine a world without Facebook, Instagram, Snapchat, Twitter or any of the other social networks available today.

However, these websites also present a danger to a young doctor’s professionalism. They are a prime example of how easy it is to blur the boundaries between the personal and the professional.

As soon as a friend request or follow is accepted, a patient no longer sees a doctor as an authoritative, well-intentioned, ultimately neutral party that is there for their health only. They get to see their doctor worse-for-wear at a social gathering, or arguing with their friends or colleagues, or otherwise being less than the professional they need to be in order to provide the best care.

As important as it is for doctors to be empathetic, there’s a lot of value in keeping distance as well—including on social media. It could be the difference between a patient trusting your opinion as a doctor, and rejecting your advice because they see you as a “friend”.

What do you do if a patient does follow you on social media?

If a patient ‘friend requests’ you on a social networking site, a straight-forward but polite message informing them that you don’t generally establish online friendships with patients, and the reasons why: it’s inappropriate and undermines the patient-doctor relationship.

Remember to tighten up your social network privacy settings as well, while you’re at it.

You can read more about the importance of social media in the healthcare setting here.

Current patients

It’s acceptable, even encouraged, to retain a friendly rapport with current patients. However, when this friendliness turns into being actual friends, there can be problems.

First, your role as a doctor requires you to remain objective and truthful with your patients. This is something that two thirds of young doctors struggle to do with patients they like.

Emotional engagement is important for patients to feel like their concerns are being dealt with, but blurring that line too far can result in a doctor giving too much of themselves to a patient’s recovery.

Doctors can end up spending their work time as well as their personal time worrying about the patient’s recovery, and this can impact on their ability to treat other patients.

This is not acceptable, and is a particular concern for doctors who treat patients with recurring/chronic conditions.

Doctors who live in the same area as they practise have a similar problem—rural doctors are likely to see their patients in social settings as well, for example.

What if you are pursued by a patient?

A doctor may be dedicated to creating a distance between them and their patients, but may still be pursued by a patient themselves.

If this does occur, the key is to re-establish the professional boundary and re-iterate expectations of the professional relationship.

Keep in mind that even small things like hugging a patient, giving out personal phone numbers (even for professional reasons) or letting patients use your first name can be enough to blur the boundaries. It can be difficult to know where empathy ends and inappropriate friendliness begins.

Keep an eye out for gifts, even small ones, flirtatious notes, texts or calls that aren’t related to their healthcare or invitations to meet socially. These behaviours must be discouraged, as ignoring them can be falsely interpreted as encouragement (playing “hard to get”).

If all else fails and the patient continues their pursuit, you may need to consider referring them to another doctor if possible.

Former patients

While pursuing any kind of relationship with a current patient is inappropriate, there can appear to be something of a gray area when dealing with former patients.

One of the primary reasons that a relationship between a doctor and a patient beyond the professional one is inappropriate is because of the inherent power imbalance between a doctor and a patient. When a patient puts their trust in a doctor to cure their ailment, and in doing so shares private and sometimes sensitive personal information, they make themselves beholden to that doctor, and thus make themselves vulnerable.

Even after treatment has finished, this vulnerability in the patient can remain. Any friendship or romantic involvement between a doctor and a patient under these circumstances, then, could be seen as manipulative on the part of the doctor.

Also consider that you may treat this former patient again in the future, especially if they suffer from a chronic ailment. An existing relationship may then make it inappropriate for you to treat them, straining both your professional and personal relationship and affecting treatment outcomes.

If in doubt, don’t pursue any former patient.

Friends and family of former/current patients

Friends and family of former or current patients are also usually off-limits, as they can create problems for the professional relationship between you and your patient too.

Imagine that you were sick, and the doctor treating you was best friends with your sibling. Would you be likely to reveal every detail about your illness to your doctor? What about if it was an embarrassing condition?

These kind of social relationships disrupt the ability of the doctor to provide treatment and can impact the quality of the care a patient receives.

A rule of thumb

In general, don’t let your social relationship with the patient take priority over the therapeutic relationship. Be aware of blurred lines. A relationship that is too close impairs clinical judgement.



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