Part Five: Thinking about professional boundaries: what would you do?

This is the latest in a series of scenarios presenting some tricky situations for you to think about (by yourself or perhaps more helpfully with others), with the aim of helping to support you in the application of the Osteopathic Practice Standards (OPS) in your practice. If you missed it, you can read last month’s blog before scrolling down to see my response to the fourth scenario – or you could just get started with the latest scenario (number 5) now.

Professional Boundaries Scenario 5

An osteopath, while out at a club one night, bumps into a former patient who the osteopath saw once or twice for a straightforward shoulder problem three years previously. They don’t immediately recognise each other, but get chatting, and after a few minutes, realise the connection. They get on well and the patient asks the osteopath out on a date.

Q: Some questions for you to consider:

• What are the boundaries issues in this case?
• What are the relevant OPS and areas of guidance to support decision making?
• If a colleague reported this case to you and asked for your guidance, what would you say/do?
• If you were presented with a similar scenario, how would you manage this?

Watch out for the sixth and final scenario in this series as well as our thoughts on this one next month.

My response to Scenario 4

As with previous scenarios, in order to consider this scenario, we need to look at OPS standard D2: ‘You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath’.

We’ve considered previously a case where the patient had been particularly vulnerable and treated over a long period. This does not seem to be the case here. So does that mean that a romantic relationship may now develop unhindered by professional constraints? Not necessarily.

One must assume an imbalance in power in a therapeutic relationship, and the osteopath will need to reflect on whether they have taken advantage of their professional status to encourage or instigate the relationship. There does not seem to have been any evidence of unprofessional behaviour during the treatment – sexualised language or unnecessary physical contact, for example.

D2.5.7 specifically states that you must not end a professional relationship with a patient solely to pursue a personal relationship with them. The osteopath may argue that they’ve taken care of the patient’s osteopathic needs by referring them to a colleague, but one might question the lack of transparency about this.

So, these two people have much in common, are single, and like each other, and may turn out to be the loves of each other’s lives. But what if it all goes wrong, and the former patient raises a concern six months later with the GOsC? It would then be for the osteopath to demonstrate how they met the standards in entering into a personal relationship with a patient. A regulator can’t legislate for relationships, but registrants should consider how they would demonstrate adherence to the OPS, should their actions be called into question.

If you would like to share your reflections with us or discuss any aspect of this or other scenarios, we would be pleased to receive your thoughts. Please email: standards@osteopathy.org.uk