Health Professionals and Patients: The Need for Appropriate Boundaries

The disciplinary proceedings against an Ontario family physician who admitted to showing naked pictures of himself to patients highlights the importance of all health professionals keeping appropriate boundaries with the people they are treating, says Elyse Sunshine.

“While the conduct in this case may seem obviously wrong and shocking, what it highlights for health professionals is that your patients are not your friends,” she tells Advocate Daily.

“Patients see health professionals to receive health care services. They aren’t really interested, nor is it appropriate, for a health professional to share details or pictures of themselves about their personal lives.”

Sunshine says that while the pictures this physician showed to his patients are apparently “quite graphic,” it’s not uncommon for health professionals to “overshare” with the people in their care, and it can lead to problems.

“One has to keep a professional distance from patients,” she says.

“There are a number of cases before professional regulators in which health professionals have been charged with professional misconduct from boundary violations. These can involve friendly hugs and kisses to sharing pictures, all the way to sexual relationships with patients. There are always concerns when the health professional allows those boundary lines to be blurred.”

Sunshine says that in and of itself, showing vacation pictures to a patient, for example, may not seem problematic but it gives an impression that the relationship between care provider and patient is more than just a professional one.In the case of the doctor who appeared before a disciplinary hearing at the College of Physicians and Surgeons of Ontario (CPSO), he said he thought his patients would find the naked selfies “humorous, innocuous,” reports the Toronto Star.

A number of complainants testified at this hearing that they felt “embarrassed, violated, and confused when their doctor showed them the photos in the examination room,” says the newspaper. “A strong yuck factor,” was how one patient put it in an agreed statement of facts filed by the College, says the article.

The physician admits to revealing four pictures of himself in various states of undress and agreed it constitutes the regulator’s charge of disgraceful, dishonourable or unprofessional conduct, says the newspaper.

“He has denied the College allegation that his conduct amounts to sexual abuse of patients,” says the Star.

Sunshine says the sexual abuse allegation is serious. She notes that if the College finds the conduct to constitute sexual abuse, it will mean a mandatory suspension for the physician and could even result in revocation.

She says that the relationship between health professionals and patients is not one of equals. Patients are always “vulnerable” and when the professional relationship boundary is blurred, even conduct that seems innocuous to the health professional may place patients in a difficult situation.

“It may start with simple disclosures and sharing personal information on the part of a health professional, but it can lead to a situation where, as here, a patient is really traumatized,” she says.

But Sunshine also says nobody wants physicians and other health professionals to be robots either.

“Professionals want to be relatable to their patients, but it is a slippery slope,” she says.

Sunshine says most health professional colleges have guidelines on maintaining appropriate boundaries with patients.

However, certain conduct, such as a sexual relationship, “is never permitted,” she says.

Some colleges also provide guidance on the use of social media, Sunshine says.

Questions that can come up are: “Do physicians accept friend requests from patients on Facebook or other social media? If they do, how does that change the relationship?” she asks.

If the Facebook page is for a medical practice, for example, and shares only information about the clinic and health-related issues, then it may be OK for a patient to be a follower of that page, Sunshine says.

However, it is likely not appropriate for a health professional to accept a friend request via their personal Facebook page from a patient because it can muddy the waters around the professional relationship, she adds.

“It’s probably not going to be viewed as appropriate if it’s the health professional's personal page,” Sunshine says.

"In today's culture of sharing, we have an ability to share information more easily than we ever have before."

But with a growing awareness around the impact of blurred boundaries with client relationships, health professionals have to be mindful, Sunshine says.

“There is increased awareness and opportunity for sharing — this is a bit of a dangerous combination for health professionals,” she says.