While Apple TV's popular show, Shrinking, makes light of a mental health professional's violation of boundaries with their patients, a recent discipline decision from the College of Physicians and Surgeons of Alberta shows that regulators in the real world don't find such conduct amusing.
The Boundary Violation
The physician in this case, a child psychiatrist in the small rural community of Canmore, Alberta, faced allegations that she displayed a lack of skill or judgment in the care of three patients: a parent, and her two children. The Hearing Tribunal found that the physician failed to maintain appropriate boundaries with the parent by:
- providing the patient with the physician's personal email address;
- engaging in casual conversations with the patient;
- disclosing excessive personal information to the patient;
- exchanging gifts; and
- providing medical appointments that were not billed for.
Although the physician explained that these actions were all taken to support the patient, the Tribunal was concerned by the physician's "repeated failure to uphold professional boundaries". The physician's conduct directly contravened the College's Standards of Practice, which state that physicians must not enter into close personal relationships with patients or any person with whom a patient has a significant interdependent relationship (e.g., parents, guardians, children, or significant others), and that physicians must not socialize or communicate with patients for the purpose of pursuing a close personal relationship.
The physician was also found to have engaged in other unprofessional conduct including engaging in unconventional treatment approaches and abruptly terminating care for all three patients.
The Penalty
The physician and the College jointly proposed a penalty that focused on rehabilitation and remediation rather than punitive measures. In determining the appropriate penalty, the Hearing Tribunal considered the fact that the physician was a specialist in psychiatry, a field that is in high demand, and especially so in rural areas. As there was a significant public need for the services that the physician provided, it was determined that it was beneficial to the public to support the physician in improving her skills rather than imposing a suspension.
The Hearing Tribunal ordered that the physician must successfully complete an Individual Practice Review with the College and remedial coursework on ethics and boundaries at her own expense. In addition, the physician received a reprimand, and was also ordered to pay the costs of the investigation and the hearing of $10,000.
Key Takeaways
Maintaining appropriate boundaries with patients are important for many reasons, including preserving the professional relationship between patients and their healthcare providers, protecting vulnerable patients, and preventing conflicts of interest. While we may typically think of "boundary violations" as involving sexual conduct, boundary violations can also occur in non-sexual context, as the Hearing Tribunal found in this case. Notably, healthcare professionals that are found to entered into personal relationships with patients, or otherwise violated boundaries, are very likely to face regulatory consequences.
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