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What are Professional Boundaries?
They relate to the way you behave in your role as a doctor, and
could relate to a range of areas of your work; for instance time,
place and space, money, gifts, services, clothing, language,
self-disclosure and physical contact.
You might cross a boundary because you think it could benefit
your patient. However, if crossing the boundary could have a
negative impact and potentially cause harm, this is known as a
Patient safety is paramount. Doctors must not use their
professional position to establish or pursue a sexual or improper
emotional relationship with a patient or someone close to them.
They must treat patients with dignity and protect them from harm
posed by another colleague’s conduct.
Developing awareness and responsibility around patients’
cultural and religious concerns is important to understand
boundaries such as touching or social invitations.
The Fiduciary Relationship
Doctors who get into trouble around boundaries often confuse
their personal life with their professional life.
It is critical that you maintain a fiduciary relationship with
your patients. It involves trust and duty - the patient places
trust and confidence in the professional who has a duty to act in
the best interest of the patient.
Breach of this trust undermines not just the doctor–patient
relationship but the public’s trust in the profession.
Disclosing Personal Information to the Patient
Disclosing personal information about yourself to the patient
can bring you closer, which may have advantages in terms of
encouraging the patient to talk about themselves – but
excessive disclosure radically changes the dynamic. In most
examples where sexual boundaries are violated, the doctor has
provided an excessive amount of information about himself or
Blurring of personal and professional lives is increasingly
played out online. The simplest approach is to have separate
personal and professional social media profiles, with the highest
level of privacy on personal sites.
Impact of Violations
Violating professional boundaries can lead to long-term
psychological issues for patients because:
- The problems they initially sought help for still remain
- The original problems have been made worse
- Their ability to approach/trust other professionals is
- Additional damage is caused by the breach of trust
Patients may feel confused or even suicidal. The doctor will
face disciplinary enquiries and professional sanction, including in
the worst cases being removed from the medical register.
Colleagues, other patients, the employing organisation, friends and
family may also be affected.
Why are boundaries important?
Boundaries keep doctors and patients safe. The professional
relationship must be upheld as patients need professionals to
behave with integrity and do their job.
What should I do if I become aware of feelings towards a
It’s normal to have a range of feelings towards patients.
Sometimes called ‘countertransference’, these are ethically neutral
occurrences. The key skill is clearly identifying these feelings,
sharing with a colleague or mentor and taking appropriate action.
Problems arise when feelings are acted on.
It’s worth reflecting with a mentor or supervisor how these
feelings developed, as there may be important lessons about working
with patients or any personal/professional issues you may have.
What should I do if I have already overstepped a
boundary with a patient?
Both GMC guidance and general professional ethics require
openness and accountability. If you believe you’ve crossed a
boundary risking causing significant harm to a patient, consider
being open about this with colleagues. As a matter of integrity,
apologise to those concerned. It’s important to also contact your
professional association, defence organisation and the GMC.
Can practitioners who have transgressed ever be safe to
There’s evidence from Gabbard and others in the USA to suggest
that rehabilitation is possible for some practitioners. The key
issue is identifying contextual and risk factors and developing
rehabilitation plans in light of these factors.
The GMC will always take action on improper relationships and
its decision-making will always be informed by the remedial action
taken, level of insight and specific circumstances of the
transgression. Openness and honesty following a transgression are
Who violates boundaries?
Multiple offences committed by psychiatrists against patients
are relatively uncommon. Assessment and rehabilitation experts
report that doctors at all stages of their careers might violate
boundaries. There are higher rates for people who are further ahead
in their professional careers.
The majority of transgressions seem to be committed by
clinicians experiencing personal and professional stress, sometimes
with additional trauma. It’s important to address personal stress
and burnout as early as possible and to communicate with colleagues
and mentors about it.
If you have concerns about a colleague, take appropriate steps
without delay. Please refer to the General Medical Council’s (GMC;
2013a,b) and the Royal College of Psychiatrists’
guidance listed at the end of this information guide (Subotsky
et al 2010; Royal College of Psychiatrists,
We thank Mr Jonathan Coe, Managing Director, Clinic for
Boundaries Studies, for his help preparing this guide.
The information is a guide only and is not a substitute for
professional advice. If you need further advice and support, please
contact the Psychiatrists’ Support Service or contact one of the
service in our
© Royal College of Psychiatrists 2016