Understanding and Respecting Professional Boundaries -- Part II

Sexual harassment is considered a form of sexual discrimination. When consensual sex is involved, the courts often rule it to be coerced when complaints are filed against the doctor. When the issue of consensual sex is litigated, the courts have ruled that even when the patient/employee voluntarily participated in sex, it can still be considered coerced if at a later date the litigant contends so, because of the position of higher authority of the doctor/boss.

Romantic/sexual liaisons with staff have been know to occur while attending postgraduate seminars. If you're married, take your mate with you.

If a practitioner can't discipline him/herself in respecting others and controlling their power in sexual relationships, regulatory agencies will question if the doctor also is undisciplined in other areas of professional responsibility and conduct.

You, not the patient or staff member, are responsible for equality and fairness in all relationships. If a patient or staff member has tendencies to flirt or invite sexual improprieties, the doctor needs to refrain from encouraging and/or participating in potential sexual encounters.

Eros and Philio Love Are Blind

Eros (human/physical) and philio (brotherly) love are blind. It is not abnormal to be physically or emotionally attracted to other human beings, but it is wrong for a doctor to use a position of authority to impose that attraction on patients or staff members. In the eyes of the courts the issue is not whether or not a person (patient/staff member) was in love or was engaged in consensual sex, but rather that a sexual complaint was filed and did the person in position of authority (doctor) participate in the sexual encounter. It does not matter who initiated the sexual encounter if the doctor participated in a sexual liaison with the patient or staff person. No doctor of sound mind can afford to become sexually involved with patients or staff. What may begin as innocuous business relationships can turn into romance. If the doctor allows that to occur, the door is opening to violation of professional boundaries.

If the patient or staff member is the initiator of the sexual advances, those advances must be thwarted in a direct and professional manner. More than one doctor has destroyed a career with a "one night stand" or some sexual misconduct.

Predatory Personalities

We all need to keep in mind that there are people who are afflicted with emotional and biochemical problems which predispose them to predatory sexual habits. When that's the situation, the physician needs to seek professional help.

Safe guards can be put in place which help prevent being put in situations where weakness can dominate or be exploited. You may not consider yourself a predatory personality but what you consider yourself to be and what the courts of law might consider (if a complaint is filed against you) is what matters.

In the same manner all physicians need to maintain a heightened awareness that some patients and employees may also have one or more predatory sexual inclinations. There are some emotionally sick and unstable people who consciously or otherwise try to entrap physicians.

Sex Can Be a Form of Power and Control

Many aspects of life are out of our control, yet we seek to be in control. People who lack love, acceptance, power or appreciation at home or in their personal lives will often attempt to gain love, acceptance and power elsewhere, particularly with people in positions of power at work or elsewhere. This commonly involves romance that develops into sexual encounters. And even if that seeker of love is deemed to have a "psychological sickness," the person in authority who gives in to that temptation is judged guilty, not the patient or staff member. Justice is not always fair and in these days justice far more often comes out on the side of the claimant than it does on the nonperpetrator.

How can you successfully argue against someone who accuses you of violating professional boundaries? The best defense against potential professional boundary accusations is incorporating systems that defensively protect you and your patients and staff. Logic tells us that no one ever gets caught in quicksand if they stay away from it. The same holds true in the area of professional boundaries.

Predatory people often seem quite nice and likable, but for one or more reasons will eventually do things that would be inappropriate or mark their potential victim in the normal patient/doctor relationship. Commonly these are lonely, insecure people. They may be anybody: married; divorced; single; heterosexual or homosexual. They are either looking to find sexual involvement with the physician or looking to create a situation where the doctor could be accused of sexual misconduct. Some of these people have deep-seated issues that become manifested in power relationships. Not entertaining the possibility of emotional imbalance in patients is just as dangerous as not taking a case history, examining or adjusting spines without having x-rays of that person's spine.

If anything, good risk management principles involve forewarning us of potential problems and offering solutions to preventing problems. Foul ups are best prevented by incorporating good risk management principles just as follow up prevents foul-ups.

Be on Guard

None of us is so naive that we are not aware of those who like us beyond that which is normal in doctor/patient or doctor/employee relations. We all have the need to be accepted and appreciated, but we cannot allow ourselves, patients or employees to become physically or emotionally attached to us beyond the morally and legally established doctor/employee or doctor/patient relationships.

When sex is involved at work the practice always suffers because productivity diminishes. We are not implying that love is wrong, but legally there is no room for anything but a busines srelationship with patients or staff members. In the long run, sexual affairs with patients or staff members do not work to anyone's advantage. The only persons who profit from sexual encounters are the attorneys who are later called to get involved in litigating the matter.

Workplace Hostility

We all attempt to hire the most compatible employees, but not all employees turn out to perform as anticipated. Unhappiness can result for all involved. You have no legal footing to try and get them to quit by making the work environment hostile. Even unlovable people are to be treated in the best possible human terms. Far too often doctors and/or a designated staff person will make life difficult for an unwanted employee. It's wrong and illegal. If you feel an employee needs to be released to another calling, tell them so in fair and humane terms. Never try to get an employee to voluntarily resign from their job by creating a hostile work environment. Practitioners who create hostile work environments predispose themselves to lawsuits.

You Cannot Be Everything to Everybody

Many of our patients bring with them emotional baggage that if allowed will spill into the doctor/patient relationship. This becomes ever more present in this day and age of insecurity, low self-esteem, poor self-worth and fractured relationships. Many people feel rejected and lonely and are looking for emotional support, love and acceptance. The self-esteem of so many people is so low that they will unconsciously or consciously look for challenges or attract situations where they are vulnerable or encourage the vulnerabilities of others to surface. Under no situation should physicians encourage or allow themselves to be exploited or in any way exploit their patients or staff.

Any time you move beyond the physical/biochemical scope of your state license you open yourself to legal problems. If patients or staff have emotional problems, refer them to an appropriate specialist. Certainly we are spirits living in a body with emotions but those practitioners who cross over the scope of practice dramatically increase their risk management barometer.

Unfortunately countless numbers of practitioners have destroyed their God-given potential for great service to humanity because they allowed themselves to cross professional boundaries and/or their legal scope of practice. In doing so many fine chiropractic practices, marriages, families and other relationships are destroyed, causing continued negative ramifications in the lives of all those involved.

Be Careful of the Pursuit of Things

Often at the core of most practice problems are relationship problems. Most of the relationship problems have their origin within us, at the core of our being. This is in part related to insecurity, comparison of ourselves to others, the amount of debt that many practitioners carry and the increasing pressure to succeed. Many practitioners have invested so much time in scientific advancement and practice building that they have neglected their inner person and/or covenant relationships. Many times instead of slowing down and getting our inner person in order and healthy we foolishly attempt to focus on building a bigger practice and acquiring more "things."

There is nothing wrong with a big practice or material positions, but it takes mature people to properly handle all the other trials and responsibilities that come with a big practice and financial success. Often practitioners spend more time in their practice with patients and staff than with family. Very often home responsibilities are left to the caregiver at home, who is neglected. Many times the financial pressures spill from the office into the home and they have negative effects in the practitioner's marriage. Because of the hours spent in the office with staff and patients, sometimes the practitioner bares those problems to a patient or staff member of the opposite sex. Very often that person is younger than the doctor's mate and doesn't remind the doctor of the household responsibilities.

The doctor may see in that person a more supportive and understanding person than the spouse. Eros and philio love may enter the relationship and sexual involvement may blossom.

Very often the setting of high or unrealistic goals causes frustration and deepening insecurity, all of which can predispose a person to try to prove themselves through the power that comes from sexually dominating patients or staff.

Have an Affair with Your Mate

The best advice we can offer you is that if you're going to have an affair have it with your mate. Sex can be exciting and it can stay exciting and fulfilling for both persons involved if they work at keeping it exciting and fulfilling for their partner.

Not all relationships last, but those we choose to consistently invest in are nurtured and last as long as both parties want them to last. Each of us should look at what and whom we're investing our time in. Where are we sowing our seeds? Is what we think, act and do positive or negative? By honestly answering those questions you'll see what kind of harvests you'll reap. Married people who put their greatest investment in their spouse and family are investing in the best possible future. The practitioner who does so eventually succeeds far beyond those who put their practice and the pursuit of material things first.

This business of relationships and treating others properly is so important that the government has stepped in to make laws that would never have been made if people had lived according to the golden rule.

Do What's Best for Others and You'll Minimize Troubles Coming into Your Life

No one is watching Joe citizen, but when a practitioner crosses the professional boundaries of sexual propriety there is hell to pay. That is when the reality of federal and state laws and the rules and regulations issued by boards of chiropractic examiners on professional boundaries and sexual improprieties take over.

Professional boundaries really involve loving your neighbor as yourself and doing unto others as you would have others do unto you.

There Are Relationship Boundaries

Everyone has different concepts of personal and professional boundaries. One's conception may not be what matters legally. The courts of law, malpractice insurers and your board of chiropractic examiners have established what are considered professional boundaries. If you give no attention to them or attempt to minimize them, you risk being accused of crossing/violating professional boundaries. If you want to keep or lower your risk of being accused of malpractice or unprofessional conduct, you need to know what statutory law is and all the rules and regulations that your board of chiropractic examiners has set forth.

What a practitioner may consider acceptable in professional and personal relations with patients and staff may be in violation of established laws or the rules and regulations of the board of examiners.