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PRACTICE MATTERS  PROFESSIONAL BOUNDARIES


Maintaining appropriate boundaries with patients is a key obligation for doctors and other healthcare professionals – but would you recognise a GP overstepping the mark? Dr Naeem Nazem offers some advice


H


EALTHCARE professionals should always be aware of their privileged position in society. There are few


professions in which you can question an individual on the most personal aspects of their life, let alone examine them or perform invasive procedures. People allow their doctor or dentist or practice nurse this liberty in order to receive appropriate treatment. In return they trust professionals not to abuse their position. And therein lies the cornerstone of any patient relationship: trust. Below are some points to consider when establishing practice policies which support maintaining appropriate boundaries with patients.


A FRIEND IN NEED Any doctor would help a stranger on the street suffering a medical emergency and MDDUS provides access to indemnity for such “Good Samaritan acts”. And if a non- patient arrived at the practice door needing immediate assistance, the practice should at minimum assess their need and treat/ signpost as appropriate. However, what happens when the situation is not as clear? Consider the scenario: a GP meets up with a friend on a Friday evening. The friend is going on holiday on Monday and forgot to pick up her repeat prescription for thyroxine medication, which will now run out during the trip. Her practice is closed for the weekend so she asks her friend to write the prescription. What should the GP do? The GMC states that doctors should,


wherever possible, avoid providing medical care to friends or relatives unless in an emergency. But does this scenario qualify as an emergency? After all, the friend is unable to collect the prescription before going on holiday so it is an urgent situation for her. Or perhaps it could be argued she is just a friend and not someone “close” to the GP? Although one or more of the arguments


above may seem persuasive, the GMC’s guidance does start by saying “wherever possible”, implying that a GP should exclude all


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A STEP TOO


the other possibilities before making a decision to treat or prescribe. In this case there are lots of other options available. For example, the friend could attend one of the many walk-in centres in the UK that are open at weekends. Or she could see a doctor in the country she is visiting and obtain a local prescription. In this case, by issuing the prescription, the GP is likely not only to fall foul of the GMC’s guidance, but also local prescribing policies and restrictions.


A FRIEND REQUEST When it comes to maintaining boundaries, another important risk area is social media. Patients can often form close bonds with their doctor or dentist and many are tempted to look them up on Facebook and may even


send a friend request. So what should a GP or dentist do upon receiving a request from a patient? Is it okay to accept? Or should these be declined even if it leads to potentially awkward moments later? Declining a friend request may be


awkward but how might a doctor or dentist feel knowing a patient had seen personal photos and details of friends and family – or that they had read personal comments posted or received on Facebook? Would it make discussing treatment plans or delicate decisions more difficult? Would it impact the level of professional trust? The GMC’s guidance Doctors’ use of social media advises that using social media creates risks, “particularly where social and professional boundaries become unclear”. It


SPRING 2017  ISSUE 16


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