Maintaining Proper Boundaries

1. Maintaining Proper Boundaries Rheumatology Grand Rounds May 20, 2010 William H. Swiggart, MS, LPC/MHSP Co-Director, The Center for Professional Health

2. Maintaining Proper Boundaries • The role of the Center for Professional Health • Take a screening test • Discuss the current rules and consequences associated with boundaries in medicine, DVD • Review the characteristics of physicians referred to the CME course on boundaries • Complete a brief evaluation

3. The Center for Professional Health Maintaining Proper Boundaries CME Course Prescribing Controlled Drugs CME Course Disruptive/Distressed Physician CME Course VUMC Faculty & Physician Wellness Committee Charlene Dewey M.D.,M.ed., Co-Director Programs

4. Boundary Violation Index • 25 Questions • N-never • R-rarely • S-sometimes • O-often

5. Boundary Violation Index Scoring • N-never (0) • R-rarely (1) • S-sometimes (2) • O-often (3)

6. Boundary Violation Index Scoring Cut off =6

7. Hazardous Affairs • DVD • prevention • Education

8. Prevalence of sexual boundary violations 3% 10% 954,224 physicians currently in practice Swiggart, W., K. Starr, et al. (2002). Sexual boundaries and physicians: overview and educational approach to the problem. Sexual Addiction & Compulsivity 9: 139-148.

9. Physician Demographics • Total Participants – 571 • Age Range - 31 to 80 (Average - 49) • Sex - Male 95%, Female 5% • States – 45 and Canada

10. Specialty • Family / Internal Medicine – 40% • Psychiatry – 10% • Surgery – 12% • OB / GYN – 7% • Anesthesiology – 3% • Others – 28% N = 571 Feb. 2000 – May 2010

11. REASONS FOR REFERRAL • Complaints from patients, family members, nurses • Affair with patient, office nurse/staff

12. Lessons LearnedTop 11 ways to get into Trouble

13. Step 1 • Date someone you supervise such as office staff, i.e., nurse, secretary, a resident or intern

14. Step 2 • If someone objects to your sexual jokes or flirting assume it is their problem. You can say anything you want to.

15. Step 3 • Prescribe scheduled drugs or operate on someone with whom you are sexually involved.

16. Step 4 • Use the hospital or office computer to view or download pornography.

17. Step 5 • Avoid even the appearance of professional boundaries in regards to dress, language and behavior in the office.

18. Step 6 • Make comments about your patients underclothing, e.g. how pretty or where did you buy that?

19. Step 7 • Tell stories about your own sexual life. This will certainly impress your patients and make them feel more at ease during the breast exam.

20. Step 8 • Be present when your patient is disrobing and offer to help with those hard to reach items. Don’t use a chaperone in your office. They only make the patient uncomfortable.

21. Step 9 • Accept offers to meet after-hours from your patients even if it is just for coffee or a meal.

22. Step 10 • Flood your life with work, long hours, and ignore your personal needs. A lack of balance between professional and personal life are set-ups for problems.

23. Step 11 • Ignore state, federal and professional guidelines regarding sexual harassment, sexual impropriety and sexual violation.

24. Slippery Slope Late appointments with no chaperone Business transactions/dual relationships Excessive physician self-disclosure Some forms of language use Personal gifts Special favors Flirting, jokes etc. Grooming behavior Casual workplace

25. Boundaries Differ in Different Specialties • Psychiatry once a patient always a patient • Primary Care • Surgeon • Pediatrician patient surrogate • Anesthesiology • Rheumatology ????

26. Key Concepts • The physician holds the balance of power over patients, staff and students. • Mutual consent is not recognized as a defense for the physician. • Patient and physician emotional vulnerabilities are at the core of boundary violations. • Self care by the physician is critical to prevent hazardous romantic relationships.

27. Web Resources http://www.mc.vanderbilt.edu/cph http://www.fsmb.org/grpol_policydocs.html#2006