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Navigating Dual Relationships

People enjoying a an outdoor meal
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Physicians need to be mindful of keeping professional role separate

Physicians’ obligations to establish and maintain appropriate boundaries with patients are not limited to sexual interactions, states the College’s recently approved Boundary Violations policy.

Boundary violations can arise within what is often referred to as dual relationships, with physicians providing professional services to patients as well as sharing social and/or business interests.

While the policy does not prohibit dual relationships, it is important for physicians to be aware of the challenges associated with managing them.

There are “dozens of different scenarios” in which dual relationships can arise between physicians and their patients, said Dr. Barbara Lent, one of the members of the policy development group. These include being members of the same tight-knit ethnic or religious communities or as participants in shared community activities, such as playing on the same sport teams or attending children’s school events.

“You need to be mindful of separating out your professional, clinical role from your role as a member of a particular community,” she said. “If you do that, you should be fine.” We have some FAQs about non-sexual boundary violations on the next page.

The “Respecting Patient Autonomy” article describes the policy’s expectations for maintaining boundaries during an examination.

FAQs

Below are some frequently asked questions about non-sexual boundary violations

How do non-sexual boundary violations impact the physician-patient relationship?
Non-sexual boundary violations can occur when a physician has a social relationship and/or a financial/business relationship with a patient.

It is important for physicians to be aware of the increased risk associated with managing a dual relationship with a patient, including the potential for compromised professional judgment and/or unreasonable patient expectations.

What kind of activities have the potential to cause harm?
The following activities have the potential to cause harm, particularly when the physician uses the knowledge and trust gained from the physician-patient relationship. These can include:

  • Giving or receiving inappropriate or elaborate gifts;
  • Suggesting patients join faith communities or other personal causes;
  • Lending to/borrowing money from patients;
  • Entering into a business relationship with a patient; or
  • Soliciting patients to make donations to charities or political parties.

What should I do when my patients are part of my social network?
The College does not prohibit physicians and patients from interacting within the same social network. In fact, we recognize that this is a reality of practice for many physicians. For example, in small communities and in religious, language and ethnic communities, physicians will be invited to, or engaged in, social events and activities with patients.

We understand that these issues can be challenging for physicians; however, as set out in the answer above, physicians need to manage the increased risks associated with having a dual relationship with a patient. For example, it is best practice for professional issues to be discussed in the physician’s office.

The College’s Physician Treatment of Self, Family Members, or Others Close to Them policy also contains important information with respect to this issue.