Issue 1 - January 2004

Ask the attorney
What is the boundary on banter?
By Mark Raymie

I am a male doctor. I enjoy relaxed, lighthearted conversation that conveys that I’m concerned about the patient as a person. But recently, a staff member indicated I might have gone overboard with a comment I made in jest to a female patient. How can I establish professional boundaries and still maintain an open and friendly rapport with my patients?

It depends. Ultimately, only the receiver can determine the manner in which a comment is interpreted. Your breezy comment of, “Wow, what a great sweater!” may be construed quite differently from the way you intended it. Your best rule of thumb is to refrain from taking chances and follow your state’s scope of practice guidelines in maintaining professional boundaries.

The monograph on Sexual Misconduct: Ethical, Clinical and Legal Ramifications and the Chiropractic Profession by Michael J. Stahl, DC and Stephen M. Foreman, DC encourages chiropractors to remember that different people may react differently to the same words or actions.

For example: Some patients may be offended by a doctor’s hug, while others may consider a hug a warm display of “tableside manner.” And to make matters more confusing for a clinician, some acts are viewed as appropriate only in limited circumstances: The patient who views a single hug as pleasantly warm and affectionate may later become offended because the behavior was repeated too often.

Since you are questioning your own behavior, you are aware there may be a problem. If you’re not sure your overall behavior and language are appropriate, ask your other staff members and colleagues if they’ve noticed any potential “trouble spots” — and ask for elaboration from the staff member who first brought the matter to your attention.

If the answers are affirmative, you’ll know specifically the areas that might need work. In addition, during most examinations and treatments, a staff member will be in the room with you and the patient, so he or she can offer feedback.

Overall, though, simply be mindful at all times of your professional boundary, which is defined as the clinical distance and respect afforded a patient who has established a doctor-patient relationship.

Clearly, if you’ve cultivated a long-term relationship with a patient who seems comfortable with your personality and clinical style, you probably don’t need to be concerned you might offend him or her. But if you’re unsure of a patient’s sensibilities, it’s best to err on the side of caution.

Follow certain common-sense rules:

• Limit non-treatment-related touching to shaking hands;

• Converse in a manner that is not overly familiar;

• Refrain from telling jokes that could be misconstrued;

• Be mindful of a patient’s personal space and don’t invade it while conversing;

• Conduct yourself professionally at all times, being mindful of your purpose: You’re there to help and heal.

Mark Raymie is vice president of regulatory compliance for NCMIC Group, Inc. a diversified financial services company and provider of malpractice protections for chiropractic professionals. For information, call 800-769-2000, ext. 349.

Disclaimer: This article is not intended for the purpose of dispensing legal advice. Please consult your attorney regarding any legal issue related to your practice.