A gynaecologist performs a routine check-up and screening for cancer of the cervix and teaches breast self-examination to a beautiful city socialite. The patient requires follow-up visits. The patient wishes to get active in fund-raising at the gynaecologist’s hospital. This requires frequent emails and phone conversations and perhaps even one or two lunch meetings.
They discover they have a lot in common in spite of a 20-year age difference and develop a friendship during the eight months of interaction. The patient will require ongoing services and may even need treatment down the road.
The role doctors play limits them from establishing personal relationships. However, because both doctors and patients are human and, therefore, social beings, these are sometimes inevitable. So what are the appropriate boundaries?
Clearly, the doctor-patient relationship is a highly privileged one in which private and confidential information is exchanged. The communication that occurs within this context is subject to unique rules, ethical, and legal boundaries. Should a doctor back away from a blurring of these boundaries?
Online social networking has introduced new aspects to this old question. Dr Sachin Jain expresses it well in a New England Journal of Medicine Perspective piece: “The anxiety I felt about crossing boundaries is an old problem in clinical medicine, but it has taken a different shape as it has migrated to this new medium.”
Whether or not physicians should engage in relationships with patients within the context of sites such as Facebook or Twitter is a matter of ongoing discussion.
Allowing some blending of doctor-patient-friend roles is likely to enhance the advice I give my patients about their health problems.
What is your opinion about the patient-doctor relationship? Do you struggle with boundaries? Do you see them as being in your favour towards better medical care? Tell us your story.
