From the Guidelines
When a physician develops personal feelings for a patient who is blurring professional boundaries, they should immediately establish clear professional boundaries and consider transferring the patient's care to another provider. This approach is supported by the American College of Physicians and the Federation of State Medical Boards, which emphasize the importance of maintaining professional boundaries and avoiding behaviors that could be perceived as unprofessional or compromising the physician-patient relationship 1. The physician should document any concerning patient behaviors in the medical record and consult with colleagues or an ethics committee for guidance. They should not act on personal feelings, as this would violate professional ethics and potentially harm the patient. If transferring care, the physician should explain this decision professionally to the patient, ensuring continuity of care.
Some key considerations in this situation include:
- Maintaining objectivity to provide optimal care
- Avoiding power imbalances and violations of trust in the therapeutic relationship
- Recognizing that personal involvement can compromise clinical judgment
- Being aware of the potential for boundary violations, including abusive behaviors, sexual behavior, or gift-giving between the physician and the patient or their family 1
- Understanding that professional medical ethics codes universally prohibit romantic or sexual relationships with current patients
In terms of specific actions, the physician may consider:
- Establishing clear boundaries and communicating them to the patient
- Documenting any concerning patient behaviors in the medical record
- Consulting with colleagues or an ethics committee for guidance
- Transferring the patient's care to another provider if necessary
- Seeking supervision or counseling to process their feelings and maintain professional boundaries.
From the Research
Appropriate Action for the Physician
The physician is faced with a situation where a patient is exhibiting behaviors that blur professional boundaries, and the physician has developed personal feelings for the patient. The most appropriate advice for the physician is to:
- Transfer the patient's care to another physician to maintain professional boundaries and avoid any potential conflicts of interest 2, 3, 4.
- This action is necessary to ensure that the patient receives unbiased and objective care, and to prevent any further blurring of professional boundaries.
Rationale for Transferring Care
The studies suggest that transferring care to another physician is a best practice in situations where professional boundaries are compromised 2, 3, 4. This approach ensures that the patient receives continuity of care while maintaining the integrity of the physician-patient relationship. The studies also emphasize the importance of effective communication and coordination during the transfer of care to prevent any disruptions or adverse events.
Inappropriate Options
The other options are not appropriate because:
- Saying nothing and continuing the physician-patient relationship as it is may lead to further blurring of professional boundaries and potential harm to the patient 2, 3, 4.
- Sharing observations with the patient and stating that it is a potential problem may not be sufficient to address the issue and may lead to further complications.
- Seeing a psychiatrist to deal with personal feelings about the patient may not address the underlying issue of professional boundaries and may not be relevant to the situation.
- Referring the patient to a psychiatrist for treatment of hypochondriasis may not be relevant to the situation and may not address the issue of professional boundaries.
Note: The provided studies do not directly address the issue of a physician developing personal feelings for a patient, but they do provide guidance on best practices for transferring care and maintaining professional boundaries 2, 3, 4. Studies 5 and 6 are not relevant to this scenario.