Non-Sexual Boundaries in Medical Practice

Adapted from: Nerissa Ferrie, Avant (Dec 2024)

📌 Guideline Basis: Addressed in Good Medical Practice: A Code of Conduct for Doctors in Australia (Medical Board of Australia).
🔸 The Code states: “Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship.”
⚠️ Risks:
- Loss of objectivity, bias in decision-making.
- Difficulty managing adverse outcomes.
- Higher likelihood of complaints when boundaries blur.
- Allegations of favouritism or improper care from third parties.
✅ Best Practice:
- Politely decline requests for care from close contacts, referring them appropriately.
- Document refusals and redirections for transparency.

👁️ Subtle warning signs often go unnoticed until too late.
🚩 Warning signs of over-dependence:
- Patient says:
  - “You’re the only one I trust.”
  - “No one else understands me.”
  - “I don’t know what I’d do if you weren’t my doctor.”
- Multiple unscheduled appointments, excessive messaging.
- Requests for support outside clinical issues (e.g., legal, emotional).
🧠 Risks:
- Burnout or emotional exhaustion for the doctor.
- Inability to maintain therapeutic neutrality.
- Missed objectivity in decision-making.
✅ Management:
- Reflect on whether the relationship still serves the patient’s best interest.
- Discuss concerns with a colleague or supervisor.
- Consider structured transfer of care if dependence is inappropriate.

💬 Doctors are often asked to provide medical reports or letters (e.g., Centrelink, insurance, Family Court).
❌ Common pitfalls:
- Becoming overly invested in patient’s legal or personal conflict.
- Writing emotive or biased reports that compromise professional objectivity.
- Using advocacy language rather than clinical reasoning.
⚖️ Consequences:
- Potential AHPRA notification for unprofessional conduct.
- Damage to medico-legal credibility in legal forums.
✅ Best Practice:
- Stick to objective clinical facts and professional opinions.
- Avoid emotionally charged language or speculation.
- Make clear the limits of your expertise and role.

🔹 Professionalism is expected even in disagreement.
❌ Examples of boundary breaches:
- Dismissing another doctor’s opinion rudely in front of patients.
- Gossiping about colleagues in clinical settings.
- Publicly criticising a peer’s management on social media or in notes.
🛑 Consequences:
- Erosion of trust in the profession.
- Inter-collegial conflict and possible complaints to the regulator.
✅ Management:
- Use professional language even in disagreement.
- Follow workplace escalation protocols if concerns about a colleague arise.
- Address disagreements in private, not in front of patients.

🗣️ “The joke patients always laugh at” may not always land well.
🧨 Risks:
- Even if meant to ease tension, comments may be misunderstood.
- Political or social opinions may be perceived as discriminatory or offensive.
- Unconscious bias may surface unintentionally.
🔎 Example:
- A patient complains to AHPRA after taking offence to what the doctor considered a harmless comment.
✅ Advice:
- Avoid controversial topics unless clinically relevant.
- Maintain neutrality and professionalism.
- Use universal, non-offensive rapport-building strategies.

🧍‍♂️ Building rapport by sharing personal anecdotes may seem helpful, but can be problematic.
❌ Examples of oversharing:
- Talking about your own health problems or family issues.
- Sharing frustrations about your workplace or other patients.
⚠️ Consequences:
- Shifts focus away from patient.
- May encourage reverse emotional dependency.
- Can impair therapeutic neutrality.
✅ Safe practice:
- If personal disclosure is used, ensure it is brief, purposeful, and clearly in the patient’s interest.
- Avoid making the patient feel responsible for your emotional state.

Boundary Area	Risk	Recommended Practice
Treating close contacts	Bias, complaints	Refer appropriately; avoid dual roles
Therapeutic over-dependence	Burnout, unbalanced care	Monitor dynamics, seek supervision
Over-involved advocacy	Legal risk	Stay factual and objective
Unprofessional inter-colleague conduct	Complaints, trust loss	Respect, even in disagreement
Humour/politics in consults	Offence, complaints	Keep it professional and neutral
Oversharing personal stories	Shifts focus	Share only if brief and clinically relevant