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.

Physician-Patient Dating

In May, 1992, the Council of the College passed the following guidelines concerning personal relationships between patients and doctors:

*"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.