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

Last month, I put forward the second 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 – or you could just get started with the latest scenario (number 3) now.

Professional Boundaries Scenario 3

An osteopath has a leaky pipe in the clinic toilet. He mentions it to a patient who’s a plumber, and who offers to take a look. He has seen the patient on and off over a couple of years, and trusts him, so asks him to check it out and repair it if possible. The patient/plumber comes back later that day, carries out the repair which takes about an hour, and leaves an invoice for £125, which the osteopath thinks is expensive for what he thought was a small job. The following week, he notices the pipe is still leaking, and is due to see the patient later that day.

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?

Remember, we would be pleased to receive your thoughts if you would like to share your reflections on this scenario with us. Please email: standards@osteopathy.org.uk

Watch out for the fourth scenario and our thoughts on this one next month.

My response to Scenario 2

As in the first scenario in this series, the focus in Scenario 2 is on standard D2 of the OPS under the Professionalism theme: ‘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.’

There is nothing in this scenario to suggest that the osteopath is motivated by anything other than kindness towards her elderly patient, though there are potential boundary breaches here – it’s not typical for an osteopath to pick up shopping for a patient, or cut their grass, for example.

That said, the patient and osteopath live in the same village, and she knows her as a former teacher. Where is the line between her doing odd jobs as a friend, and her osteopathic role?

D2.5.9 acknowledges that osteopaths who practise in small communities may find themselves treating friends or family and, in such cases, establishing and maintaining clear professional boundaries will help to ensure that clinical judgement remains objective.

So, what could be the issue here? It’s important to consider how such a bequest could be seen by the patient’s relatives. Might it appear that the osteopath has used her position to influence the patient, for example, even if this is not the case? As an elderly woman with mobility issues, she is potentially quite vulnerable. The OPS do not specifically mention the acceptance of gifts or bequests from patients, but the GOsC, along with other regulators, do publish guidance on conflicts of interest.

The fact that the patient has informed the osteopath of her intentions puts her on notice. The most ethical approach may be to say that there is no need to leave such a generous bequest, and that it could cause difficulties. It’s important to be clear that her osteopathic care is not influenced by any potential gift or bequest. Perhaps, instead, she might suggest a donation to a charity.

Remember, we would be pleased to receive your thoughts if you would like to share your reflections with us. Please email: standards@osteopathy.org.uk