Part Four: 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 third scenario – or you could just get started with the latest scenario (number 4) now.

Professional Boundaries Scenario 4

An osteopath sees a new patient, and they get on very well from the outset. The patient has low back pain, which responds well to treatment. During the consultations, they chat about general things and realise they have much in common. Both are sporty, competing in triathlons, and both have dogs, and enjoy going on long walks. After the third weekly session, the patient reports an 80% improvement in symptoms, and the osteopath suggests they spread the treatment out with another session in two weeks. The patient agrees, but on leaving says, ‘actually, would you like to meet for a drink one evening?’ The osteopath explains that they would not be able to see the patient for treatment any more if they were to meet socially, and would need to refer the patient to a colleague. The patient understands this, and is happy to be referred. On this basis, the osteopath agrees to meet the following Friday evening and, in the meantime, books the patient in with a colleague at the practice. The osteopath does not explain why to the colleague.

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 fifth scenario and our thoughts on this one next month.

My response to Scenario 3

As we know from previous scenarios in this series, D2 is the standard that requires osteopaths to establish and maintain clear professional boundaries, and not abuse their professional standing.

D2.4 states that you should be aware of the risks to patients and to yourself of engaging in or developing social or commercial relationships with patients, and the challenges this might present for the therapeutic relationship and to the expectations of both patient and professional.

The scenario here (number 3) illustrates the problems that can arise. The osteopath feels that the patient may have overcharged him, and now the pipe is still leaking, which adds further to his frustration and to the awkwardness of the situation.

The therapeutic relationship and the patient’s wellbeing are the priority here. Can the osteopath put aside his feelings and focus on treating the patient objectively and professionally? Hopefully so. What about the leak? Should he tell the patient and ask him to rectify this? Well, he’s realised and reflected on the potential issues in entering into commercial relationships with patients, and he may consider the best option is to put this down to experience, and call another plumber.

D2.5.9 acknowledges that osteopaths who practise in small communities may find themselves treating friends and family, and this could be extended to those for whom they have a commercial relationship too. The important thing is to remain objective, and provide the same level of care to all patients, whether or not you know them in a social or other capacity. If this isn’t possible, then osteopaths need to take action in the best interests of the patient, which might include referring them to another osteopath or healthcare practitioner.

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