Monday, July 19, 2010

Boundaries

Doctor and patient, running a marathon together. Such an inviting story, it just warms the cockles of your heart:
“I got to thinking, Hey, I’m going to take full advantage of my health now — I’m going to do a triathlon,” he said.

To raise the stakes, he decided to challenge Stewart, who was not a likely triathlete, either. As a doctor who performs 400 heart surgeries a year, each about six hours long, Stewart did not have much spare time to spend at the gym. His usual dinner, he said, was pizza or Taco Bell.

But he accepted O’Keeffe’s challenge, even if he had doubts.
And on the surface, it seems like such an ideal story.

But in reality, blurring the divide between doctor and patient can present considerable problems, too. Psychoanalysts have long understood this problem; they call it countertransference. Maintaining boundaries in our relationships with patients maintains one's ability to remain objective while assessing conditions and while providing recommendations for appropriate therapies. Further, doctor-patient boundaries avoid the potential for a perception of favoritism between patients. For instance, what might other patients that are not invited into the cozy comfort of their doctor's personal life perceive?

This is not to say it is not important to develop professional relationships built on trust with patients. But trust requires us to sometimes recommend things patients might not want to hear if we feel it's in their best interest. This might be harder to do if a relationship becomes enmeshed. Our job is not to be people's friends, but their doctors - and maintaining a healthy divide between professional and social "friends" can be very difficult at times.

So if people wonder why I don't "friend" them on Facebook, it's not because I don't like them. On the contrary, it's because I must respect the delicate boundary that must be maintained between a doctor and patient in order to maintain our professional relationship.

-Wes

9 comments:

Jill of All Trades, MD said...

Well-Said :)

Bob said...

OK so why not tell your readers what the cockles of your heart are Dr. Wes. I looked it up http://bit.ly/bBE7CK

rlbates said...

I agree with you Dr. Wes.

Bongi said...

it is something i have recently struggled with. i have only ever befriended one patient on facebook and that was after they were a patient.

even then i wondered if i was doing the right thing.

jimbino said...

I don't need a doctor to "friend" me, but I need one who posts his prices, cash discounts, etc, on the web.

Anonymous said...

I had a doctor I connected with who later left the geographical area. We had a purely professional relationship, but joked during visits, etc. I emailed him about a year later when I needed a recommendation to a specialist like him in my area, but had no response.

Am I wrong to imagine he received my email and didn't wish to acknowledge me? It was friendly, yet a purely 'businesslike' request for a recommendation.

Anonymous said...

It's just much harder to maintain when you're married to a doctor and most of your friends are doctors - and along comes something that requires the "best of the best" and you now find yourself in the care of your friend who is a doctor.

Lisa Stockwell said...

I agree with the need to set boundaries between doctor and patient, but there is value in improving communication. Rather than consider Facebook a platform for making friendships, you can set up your Facebook page for business communication and post health information you believe to be valuable to your patients. Let them comment on its value as well as ask questions that help them manage their own healthcare.
There are many doctors doing this really well online. It's new, so the jury is out on how much it will improve medical care. But I can see benefits.

Brian said...

I'm wondering if it may even be a HIPAA violation to "friend" a patient on Facebook in some cases. Say a psychiatrist friends a patient and that patient says something like, "thanks for the great session doc." on his/her wall. That person has now been identified as a psychiatric patient. Thoughts?