Maintaining Proper Boundaries

Rheumatology Grand RoundsMay 20, 2010

William H. Swiggart, MS, LPC/MHSPCo-Director, The Center for Professional

Health

Maintaining Proper Boundaries

The role of the Center for Professional Health

Take a screening test Discuss the current rules and

consequences associated with boundaries in medicine, DVD

Review the characteristics of physicians referred to the CME course on boundaries

Complete a brief evaluation

Programs

Maintaining Proper Boundaries CME Course

Prescribing Controlled Drugs CME CourseDisruptive/Distressed Physician CME

CourseVUMC Faculty & Physician Wellness

CommitteeCharlene Dewey M.D.,M.ed., Co-Director

The Center for

Professional Health

Boundary Violation Index

25 Questions N-never R-rarely S-sometimes O-often

Boundary Violation Index

Scoring N-never (0) R-rarely (1) S-sometimes (2) O-often (3)

Boundary Violation Index

Scoring

Cut off =6

Hazardous Affairs

DVD prevention Education

Prevalence of sexual boundary violations

3% 10%

954,224 physicians currently in practice

Swiggart, W., K. Starr, et al. (2002). Sexual boundaries and physicians: overview and educational approach to the problem. Sexual Addiction & Compulsivity 9: 139-148.

Physician Demographics

Total Participants – 571

Age Range - 31 to 80 (Average - 49)

Sex - Male 95%, Female 5%

States – 45 and Canada

Specialty

Family / Internal Medicine – 40% Psychiatry – 10% Surgery – 12% OB / GYN – 7% Anesthesiology – 3% Others – 28%

N = 571Feb. 2000 – May 2010

REASONS FOR REFERRAL

Complaints from patients, family members, nurses

Affair with patient, office nurse/staff

Lessons Learned

Top 11 ways to get into Trouble

Step 1

Date someone you supervise such as office staff, i.e., nurse, secretary, a resident or intern

Step 2

If someone objects to your sexual jokes or flirting assume it is their problem. You can say anything you want to.

Step 3

Prescribe scheduled drugs or operate on someone with whom you are sexually involved.

Step 4

Use the hospital or office computer to view or download pornography.

Step 5

Avoid even the appearance of professional boundaries in regards to dress, language and behavior in the office.

Step 6

Make comments about your patients underclothing, e.g. how pretty or where did you buy that?

Step 7

Tell stories about your own sexual life. This will certainly impress your patients and make them feel more at ease during the breast exam.

Step 8

Be present when your patient is disrobing and offer to help with those hard to reach items. Don’t use a chaperone in your office. They only make the patient uncomfortable.

Step 9

Accept offers to meet after-hours from your patients even if it is just for coffee or a meal.

Step 10

Flood your life with work, long hours, and ignore your personal needs. A lack of balance between professional and personal life are set-ups for problems.

Step 11

Ignore state, federal and professional guidelines regarding sexual harassment, sexual impropriety and sexual violation.

Slippery Slope

Late appointments with no chaperone Business transactions/dual relationships Excessive physician self-disclosure Some forms of language use Personal gifts Special favors Flirting, jokes etc. Grooming behavior Casual workplace

Boundaries Differ in Different Specialties

Psychiatry once a patient always a patient

Primary CareSurgeonPediatrician patient surrogate

AnesthesiologyRheumatology ????

Key Concepts The physician holds the balance of

power over patients, staff and students.

Mutual consent is not recognized as a defense for the physician.

Patient and physician emotional vulnerabilities are at the core of boundary violations.

Self care by the physician is critical to prevent hazardous romantic relationships.

Web Resources

http://www.mc.vanderbilt.edu/cph

http://www.fsmb.org/grpol_policydocs.html#2006