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In a patient doctor relationship, one of the realities is that our roles limit us from personal relationships.  Do things get personal?  I suppose inevitably as long as we are both human they will.  But we do our best to stay professional and use the standard of practice and the guidelines presented by our profession’s specialty board to help counsel us.  Because of years of increasing litigant awareness on both sides, patient and physician, this has culturally become important.

Each physician must decide what defines their ethical boundaries in their practice of care.  Each patient at some point must understand that there is a difference between what they are receiving and what they are giving in this relationship.  The patient doctor relationship is different from a friendship in part because there is an unequal level of power between them that opens up a huge index of interpretations on motives, intentions and fair play.  It also robs the patient of receiving what is considered a more objective level of treatment.  When things are personal, it’s more difficult to be objective.  It’s more difficult to do our job.

When I was in medical school, the psychologist I saw became intensely special to me.  She was the one who saw my vulnerabilities in every color.  Even though I cried regularly, brought her gifts that, thank God she accepted, and felt affection toward her, she somehow reciprocated without making me think I’d ever hear about her personal life, see her cry, receive gifts from her nor affection beyond what was appropriate for our professional exchange.  I learned so much from her but wish I could learn more.

Physicians do different things to help themselves learn and practice professionally.  It isn’t easy.  After all, we have feelings.  Some of us have temperaments that are naturally what culture would consider professional; temperaments that predispose for cognitive processing, naturally not personalizing what isn’t about us and have needs outside of interpersonal relationships.  Other physicians are designed to bring people into our inner space, and when that is not considered ethical, have an ongoing degree of struggle to maintain distance.  It is an important skill for anyone who plans on practicing outside of prison to learn quickly.

In psychiatry, historically when we used to do more psychoanalysis, it was accepted practice to collect all fees at the beginning of the session.  The patient placed the money on the table where it stayed throughout the hour as a reminder that this is a professional relationship.  I have chosen to maintain a variation of that practice where I try to collect the fees in cash from patients rather than my staff.  Sometimes when I’m behind or such I’m not able to but I try.  My hope is that Freud got something right and that the patients, at some level, register that I am hired for a medical service which is perhaps more than friendship.  You can imagine how this is less obvious to some seeing their psychiatrist rather than their podiatrist.

I have other support to help also, such as through my malpractice insurance, CAP-MPT.  They are wonderful.  They are available any time for a phone or email consultation on any question I have.  (I believe they know my name by now.)  They also send out regular newsletters on related topics to their clients which I read seriously and try to implement.

Before writing FriendtoYourself.com, I was much more guarded.  I never treated friends or family and felt isolated from my community which I thought I was doing to maintain patient confidentiality issues.  I’m so glad that has eased up a bit inside of me.  I’m a better physician because of it.  I will continue to learn about this dynamic balance in patient doctor relationships from my patients and from experience and welcome the growth.

Self-Care Tip – Give yourself the benefit of keeping a professional in your life who knows their role.

Question:  What is your opinion about the patient doctor relationship?  Do you ever struggle with boundaries?  How do you see those boundaries as being in your favor of getting better medical care?  Please tell us your story.

Related articles

• It’s All About Prevention and the Doctor-Patient Relationship (prweb.com)
• The Price of Precaution and the Ethics of Risk (bioethicsdiscussion.blogspot.com)
• Reworking Choices With Your Physician as Part of Your Team (friendtoyourself.com)
• APA Guidelines for Practitioners (protectivemothersalliance.wordpress.com)
• Should a doctor block his/her patients on Google+ or Twitter? (casesblog.blogspot.com)