Boundary violations are one of the most common reasons why complaints are made about medical and health practitioners and one of the most potentially damaging experiences. Establishing and maintaining clear professional boundaries is a key principle of ethical practice as a health practitioner. The responsibility for maintaining boundaries rests with the health practitioner not the client. To effectively manage professional boundaries requires vigilance and an awareness of where there may be risk of a boundary violation with a client.

The importance of clear boundaries

A study recently published in the Medical Journal of Australia examined allegations of sexual boundary violations notified to Australian Health Practitioner Regulation Agency (AHPRA) and NSW Health Professional Councils Authority from 2011-2016. Allegations involving sexual relationships were less common than allegations of sexual harassment or assault. However just over one-quarter of all allegations involved a sexual relationship.

As a medical or health practitioner, it is important to establish clear lines you do not cross. If a patient does approach you, be polite, but firm and clear in declining. If you are concerned the patient may be resentful or react badly, it can be helpful to stress that this is a professional issue. You can refer to there being rules for doctors in explaining why it is not possible for you to accept an invitation.  Inform a practice manager or colleague. They may also need to help you to manage the situation if you need to end the therapeutic relationship with the patient.

Record all interactions

Always document what has occurred, in the patient’s record. This may only be a brief note, being as objective as you can, since the record may be accessed by third parties. For example, this may record details along the lines of:

  • Any inappropriate approach from the patient (e.g inappropriate advance/suggestion by patient).
  • Your response politely declining the approach.
  • Your explanation to the patient that it is not appropriate and unprofessional.
  • The patient’s response (e.g. accepting and understanding or upset).
  • Discussed with the practice manager/colleague.
  • Care to be transferred and those arrangements.

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Relationships with past patients

It is never acceptable to have a sexual relationship with a current patient. Relationships with past patients may not be quite so clear cut, however they can still be problematic.

The Royal Australian and New Zealand College of Psychiatrists considers sexual relationships with former patients are always unethical, whether or not they are consensual.

Tego Insurance wants you to be Protected

If you do find yourself in a situation where you are concerned a line has been crossed, honesty and transparency are the best option from the outset if concerns are ever raised.

We are Australian medical indemnity insurance providers and cover your practice with medical indemnity insurance, doctors indemnity insurance, GP medical indemnity insurance, medical malpractice insurance, medical practice insurance, and more. If you are a medical practitioner with Tego, we offer 24/7 medico-legal advice and support to guide you through what you need to know about boundary violations and notifications.

This publication is general in nature and is not comprehensive or constitutes legal or medical advice. You should seek legal, medical or other professional advice before relying on any content, and practice proper clinical decision making with regard to individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Tego Insurance Pty Ltd is not responsible to you or anyone else for any loss suffered in connection with the use of this information. All content on this page has been written in a generic way, and has not been presented with any knowledge of your personal objectives or financial needs.