“Hey Coach, I have a big problem”
“Tell me about it.” I replied
“Well… I have this patient that I kind of screwed up with….”
Yes, this is a real conversation that I have had many times as a mentor and coach to chiropractors. The “problem” normally results from crossing the vague Doctor/Client professional boundary. So let’s talk about what that boundary is and how to avoid some of the common pitfalls that I have seen good honest chiropractors unknowingly cross.
What is the Doctor-Client boundary?
A boundary is defined as a border or dividing line. A chiropractic-patient relationship is based on trust. There is an assumption that a chiropractor will always act in the client’s best interest. This relationship is a professional relationship that must have clear boundaries that delineate the physical and emotional limits of all interactions. Similar to an employer, the doctor will always hold a position of power over their client.
Given this, most doctors are often surprised to hear that it is actually the client that establishes the boundary in the relationship. Let me explain. The client sets the boundary because it is always their perception that defines when the boundary has been crossed. A routine comment, question, or physical contact could be interpreted very differently from client to client.
Chiropractors routinely develop exceptional rapport with clients; the hallmark of which may be clients that come for years of maintenance or wellness care. However, long-term connections with clients can also allow for the relationship to become too familiar. Additionally, the hands on nature of chiropractic examinations and treatments open more risks to well intentioned doctors. The power of communication can never be underestimated nor underappreciated. When examining or treating a person you are always entering personal space. The more we can explain what we are going to do and why we are doing it the less we create a boundary concern.
Common Boundary Risks
It is important to recognize situations that can give rise to boundary issues and manage them appropriately. Some of the boundary issues that I have seen over the years include:
- Providing too much personal information to a client (my marriage sucks)
- Complicating the relationship with a client by entering into a business relationship (e.g., multi-level marketing)
- Entering into a personal relationship with a client
- Giving or receiving gifts
- Projecting your values on the client
- assuming they value wellness when they want band aid care
- asking them to support a cause you value (local foodbank, church).
- Providing care in social rather than professional settings (can compromise objectivity)
- Seeing clients after regular office hours
- Breaching patient confidentiality
- Probing patients for inappropriate personal information
- Offering unsolicited advice regarding non-clinical issues
Please keep in mind that these are simply examples that I have seen turn into boundary breeches. Many of these situations could be very appropriate with the right client. For example, do not stop seeing an acute client on a weekend if you don’t feel that there is a potential to cross a personal boundary. However, if you are attracted to a client or they continuously flirt with you it is wise to avoid seeing them outside normal office hours.
The world has changed since I started practicing with my single computer with monochrome monitor, dot matrix printer, and no Internet connection! Social media brings a whole new arena for boundary discussions. Many professional regulators are starting to issue guidelines around use of social media in professional practice. Generally, it is wise to set up an office page and limit clients to connecting with you through your professional site. It is important to keep in mind that social media is an easy way to breach privacy so watch what you post and get consent before posting client info.
Communication is critical to establish clear agreements around practices in your office. It is a smart practice to start with your team and create policies that your office will commit to upholding. Whenever possible share this with your clients with a written agreement. This can look like an office policy and procedure document that your clients read and sign upon becoming practice members. Posting a charter of responsibilities for both doctor and client in your reception area will ensure that you communicate expectations around full disclosure, finances, behavior, etc.…
Train and empower your team to recognize and deal with challenging clients. Never underestimate the insights of your staff. Make sure you listen to them as they have completely different exposure to your clients and can be more objective in certain circumstances.
If you need any help clarifying boundaries, start with your values. These are an integral part of who you are and how you operate. If you are not sure what these are then consider a Full Circle coach who can help you determine what they are.
This will not only put you on the right path to securing those boundaries but it will help you filter every life and business decision through them which will ultimately lead to resounding success in all aspects of your life and business. .
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