Series Review: Thinking about professional boundaries: what would you do?

Over the past few months, we have looked at a range of scenarios to help you consider the types of boundaries issues which might arise in practice, and how these might be addressed and managed.

We have showed how using the Osteopathic Practice Standards (OPS) can inform and support decision making. And how considering these issues helps support your own reflection and continuing professional development in applying the OPS to actual practice, particularly in the areas of communication and consent, and professionalism.

We know from the NCOR analysis of concerns and complaints data, and our reflections on this, that concerns and complaints relating to boundaries are on the increase. Boundary issues might be sexual in nature, but this is often not the case, and we have tried to illustrate how potential boundaries scenarios may arise in other areas too. 

I hope that the cases we have looked at in this series have been helpful and thought provoking, and that they have led to some interesting discussions with your colleagues. We plan to return to this subject later this year, and develop some further scenarios to illustrate how the OPS can help us navigate effectively through the challenges of practice.

You can review the whole series of scenarios. Or take a look at one or more below:

Scenario 1: Potential personal relationship developing with a vulnerable patient.

Scenario 2: Patient decides to leave osteopath some money in their will. (Plus response to Scenario 1)

Scenario 3: A commercial relationship with a patient. (Plus response to Scenario 2)

Scenario 4: Arranging to meet up socially with a patient. (Plus response to Scenario 3

Scenario 5: Meeting a former patient by chance while out one night. (Plus response to Scenario 4)

Scenario 6: Being asked out by a patient. (Plus response to Scenario 5)

To round off the series, here is the response to scenario 6, published in December:

My response to Scenario 6

There is nothing in this scenario to suggest that the osteopath has acted in an unprofessional way, nor encouraged the patient in his now openly stated attraction towards her. Once again, we can look to standard D2 of the OPS and its guidance to consider how the osteopath might manage this situation.

D2.5.4 states that it is the osteopath’s responsibility not to act on feelings of sexual attraction to or from patients. The osteopath in this case is certainly not considering taking the patient up on his offer of a drink, and is looking for a way to turn him down gently.

D2.5.5 states that if a patient ‘displays sexualized behaviour’, you should seek advice from a colleague or the professional body (the Institute of Osteopathy) as to the most appropriate course of action. The key issue outlined is that if you cannot remain objective and professional, then you should refer the patient to another healthcare practitioner.

The challenge will be to clearly and professionally explain to the patient that she must decline his offer of meeting socially, and that the therapeutic relationship needs to be based on clear professional boundaries. She needs to consider whether she does feel able to continue treating the patient, and even if she does, let him know that if he prefers, she could refer him to a colleague to continue his treatment. Standard A7 applies here too. The guidance to A7 makes it clear that you are not obliged to accept any individual as a patient, but if you do, and then feel that you cannot continue to provide the good quality care to which they are entitled, you may decline to treat them further and refer them to another osteopath or healthcare practitioner. Reasons given as examples in the guidance include where patients are aggressive, where they seem to lack confidence in the treatment you’re providing or if they have become overly dependent on you.

So the osteopath needs to consider whether she feels able to continue providing good quality and objective care and, if not, offer to refer the patient elsewhere. She is not obliged to continue treating a patient who has or continues to behave inappropriately towards her, or who makes her feel uncomfortable in this way.

Please do get in touch if you would like to share your reflections on any of the scenarios or any of the issues raised, or if you have ideas for scenarios you would like us to consider in the future. Please email: standards@osteopathy.org.uk