Boundary Violations: Let's Talk About Them
There were many unforgettable moments for me in this week's show, but I want to focus on one in particular.
I don't know what you were thinking when you heard Dr. Bruce Campana admit that he asked out a patient during his residency after providing care for her orthopedic injury. It made me uncomfortable for two reasons. First, he was so jarringly honest about it. Second, as you heard on the show, the same thing happened to me early on in my career as an emergency physician.
If you missed it, you can listen to an extended cut of our conversation now:
At the end of our talk, Campana made a gallows humor-type remark about going to jail for his confession. I don't speak for the College, but I sincerely doubt that's likely to happen to either of us. My 'violation' occurred more than 20 years ago, well before the College of Physicians and Surgeons of Ontario convened its Task Force on Sexual Abuse. Subsequent to that, the Ontario College published the following Policy on Physician-Patient Dating. Please note that policy is currently under review.
In May, 1992, the Council of the College passed the following guidelines concerning personal relationships between patients and doctors:
1) Sexual relationships between doctors and patients during treatment are prohibited. (See also the legislative definitions of professional misconduct).
2) When the doctor-patient relationship involves psychoanalysis or psychotherapy, sexual relations with the patient is prohibited at any time after termination of the treatment.
3) Where the doctor-patient relationship has, at any time, involved psychotherapy of such duration that it may be seen to have been a significant component* of treatment, sexual contact with the patient is also prohibited at any time after termination of treatment.
4) In all other cases, the general rule is that physicians should not have sexual contact with a former patient for a period of one year following the date of the last professional contact with the patient, even if the physician has formally terminated the professional relationship. In some instances, it may never be appropriate for a post-termination sexual relationship to develop. In others, it may be unnecessary to wait for one year before a sexual relationship can develop; for example, an emergency room physician who has treated a patient on one occasion.
*"Significant component" is defined as distinct from superficial, supportive psychotherapy administered infrequently or on isolated occasions and as incidental to the overall doctor-patient relationship. "Counselling" which is to be considered distinct from psychotherapy, is defined as a form of treatment in which the physician engages in an educational dialogue with the patient, on an individual or group basis, where the goal of the physician and the patient is to become aware of the patient's problem or situation and of modalities for prevention and/or treatment.
Don't get me wrong. It is not approrpiate under any circumstances to violate the boundary between health professional and patient. But sometimes, the boundary isn't always easy to see in real time. In retrospect, I recognized the inherent power imbalance between doctor and patient and vowed never to do it again.
I can't speak for Campana as to why he told us his story. What I can say about myself is that I'm tired of the tyranny and the hypocracy of silence that pervades my profession. I've seen it all too often in medicine, where we're taught by example NEVER to talk about our errors, our faults and our foibles. On my side of the gurney, you tend to get condemned, rather than applauded, for coming clean. But how can we learn and grow as physicians and as human beings if we're too afraid to face ourselves and each other?
I don't know how you reacted to Campana's story. But I admire his guts for telling it.
You may not agree. But that's real medicine from my side of the gurney.
Categories: Past Episodes
Previous Comments (3)
As a 15-year-old teemager in the early 70's our small town doctor was a sexaul predator. He seduced several of my friends including myself.
He would scedule appointments at the end of the day so the appointment continued after the receptionist went home.
He would tell me he loved me, encouraged me to go on the pill so that I would have sex with a boy, then after that occurred, during another after hours appointment, he encouraged me to take off my clothes and then he came into the examining room naked expecting us to have a sexual encounter. That is where I ended this 'romance'.
Although 2 years later when I was living in an apartment with a girlfriend he came over and continued to have sexual relations with my friend.
This doctor was in our small community for a number of years.... I wonder how many young girls and mothers he seduced that I don't even know of....and I wonder if anyone has ever reported him.... I never have, but now that I have a teenage daughter of my own I realise what a tragic thing this doctor has done to so many of us.....Nikki Laine, September 1, 2008 3:27 PM
Firstly, It's never an affair when a health care professional has a sexual relationship with a patient. It is sexual abuse.
Secondly, Dr. Campana's comment about going to jail is ludicrous although we know that physicians are worried about sanctions.
According to the College of Physicians and Surgeons of Ontario (licensing body)annual report of 2005, there were 13,235 calls of concern, 2370 investigations done and 34 were sent to Discipline.
Of those sent to Discipline there were 5 who had their licenses revoked for any reason, not just sexual abuse. Not much need to worry about sanctions when you look at how self-regulation works.
Those abused by health care professionals can get support at
My wife had sex with her patient.
soon after this, they moved in together.
She transfered her patient to another docter in the same practice, I was assured this was acceptable, we are divorcing.