Issue 3 - March 2005

The dual relationship dilemma
By Angelica Redleaf, DC

As you network and build your practice, your patient files become filled with individuals of varying skills and expertise. It would seem natural — and good — to call upon these patients when you need something.

For example: When you need a dentist, you make an appointment with a patient who is a dentist, or, when you need a lawyer, a house cleaner, a lawn maintenance person, etc. you seek out your patients who work in these capacities.

Doing this is a matter of tit for tat, no? An innocent business arrangement?

Whenever you and a patient exchange expertise or services, the two of you enter into a dual relationship. And it is not a problem. The situation does, however, have the potential to become a problem if something goes wrong in that relationship or with the service provided for one another.

I am not saying never to engage in a dual relationship with any of your patients. I am saying that a dual relationship is hazardous and when it goes wrong, it can go very wrong.

I would like to share some dual-relationship experiences I have had. The examples represent the kinds of challenges that could arise in your practice.

A FRIEND

For many years I have had a friend who knew I was a chiropractor. Throughout most of our friendship, her spinal health and her health in general were not an issue. But one day when she was experiencing some persistent neck pain, she asked me to take care of her. I did.

Then she began asking me more often to care for her. She involved me in all of her health problems. I began to feel that she was taking advantage of me and our friendship.

It was too much! I finally told her that her involvement of me in her health issues was affecting our friendship. We were able to resolve the issue after that conversation.

How could I have handled the situation better? After her first request, I should have set the boundaries for our professional relationship. I should have said, "Why don't you call the office tomorrow morning and make an appointment?"

MY DENTIST

I was (and still am) the patient of a dentist who later became my patient.

When he came to me for treatment, he said he was covered under an insurance plan provided through his wife’s employer. I was unfamiliar with that insurance program, but he assured me the plan would pay for his chiropractic care.

He had four visits and I billed the company. The claim was denied. When my assistant called the company, we were informed that this patient did not have chiropractic coverage.

I called the dentist and he told me that the insurance company was wrong. My office billed again; the claim was denied again; and we called again — to no avail. Chiropractic was not covered under the plan.

I called the patient and informed him that he needed to pay his bill with me. After some time he finally paid the bill. But my feelings about him changed. I now have more insight into his stinginess and I like him a bit less.

When I go to his office, I pay immediately. I expected to be treated with a similar courtesy.

How could this have been handled better? Hindsight is keen. In the beginning, I should have reviewed my clinic’s financial policies with him. And when he dragged his feet on paying, I should have been firmer and insisted that he send a check.

BOUTIQUE OWNER

For many years a patient and her family have been coming in for care at my office. They own a boutique and at one point invited me to see their merchandise, which was lovely.

I have been shopping at their store and they have been my patients for approximately 25 years.

Why does this work? Neither party takes advantage of the other. We treat each other as customers who claim no special favors.

GUIDELINES FOR DUAL RELATIONSHIPS

Dual relationships can work out (as the example of the boutique owner shows). Here are some guidelines to make them work:

1. Know yourself and the other individual. How mature are both of you? How well do you listen and communicate? Are you OK with confrontation?

2. Establish clear boundaries. It’s always up to you to make sure the boundaries are very clear and to say something if things are not going as well as you think they should.

3. Write out your agreement. Create a “contract” that stipulates what each of you agrees to do, by what date. Spell out the course of action if either of you become unhappy with the relationship.

Following such guidelines can prevent the most common complications of a dual relationship.

Angelica Redleaf, DC, has been in practice in Providence, R.I., since 1978. She is the author of Behind Closed Doors: Gender, Sexuality & Touch in the Doctor/Patient Relationship (1998) and is an instructor on boundary training for ChiroEcoCE.com. She is also a consultant to state licensing boards and individual chiropractors and lectures around the world on the topics of sexual boundaries, ethics and addiction issues.

Dr. Redleaf welcomes questions that may be appropriate to answer in this column. She can be contacted at angelchiro@aol.com.