Stay within the boundaries.

Being a treating physiotherapist puts a practitioner in close contact with a patient.

This means that understanding your obligations regarding professional boundaries is pivotal.

This article discusses a clinical scenario where a physiotherapist has crossed professional boundaries and provides safeguards to avoid professional boundary violations.

What are professional boundaries?

The Physiotherapy Board of Australia’s Code of Conduct establishes the requirements for physiotherapists to maintain professional boundaries.

The Code of Conduct describes professional boundaries as a clear separation existing between professional conduct aimed at meeting the health needs of patients and a practitioner’s own personal views, feelings and relationships, which are not relevant to the therapeutic relationship.

The aim of professional boundaries is to promote good care for patients and to protect both parties.

Clinical scenario

Margaret attends for an initial consultation with physiotherapist Brian.

Margaret provides Brian with her X-ray report, which shows that she has right shoulder subacromial bursitis.

She informs Brian that she has never been to a physiotherapist before.

Brian says that he has seen this many times and that he believes a soft tissue massage may assist with Margaret’s shoulder injury.

As Brian commences treatment, he begins to chat about his weekend and asks Margaret about hers, with the aim of making her feel comfortable during the treatment.

The discussion shifts to hobbies and interests and Brian and Margaret start to chat about their favourite TV show.

Margaret is satisfied with the treatment and is happy that they got along well.

The next day, Brian reaches out to Margaret via text message, as her contact details were on his file, to ask how she’s feeling.

During the text conversation, they continue the discussion about the TV show, mixed in with Margaret reporting on how she is recovering.

Brian decides to ask Margaret to come over to his house to watch the show together and Margaret agrees.

Margaret eventually becomes dissatisfied with Brian’s treatment and makes a complaint against him.

Brian has breached his professional obligations under section 8.2 of the Code of Conduct by using his professional relationship with Margaret to develop a friendship, including contacting Margaret via text message, which was only made possible due to her existence as a patient on his records, and discussing with Margaret personal information such as his hobbies and interests, which are not relevant to the therapeutic relationship.

Learnings and safeguards

Brian and Margaret cover a common scenario.

The discussion starts as a low-level transgression, which progresses to a clearer professional boundary violation when Brian sends a text message to Margaret and to a very clear violation when Brian invites Margaret to his house.

Professional boundaries are critical to ensuring that effective care is provided to patients.

The friendship between Brian and Margaret may result in Brian becoming more casual when consulting Margaret and losing impartiality, resulting in a compromise of the therapeutic relationship.

Professional boundaries violations have the potential to lead to significant adverse results for patients and as a result the Physiotherapy Board of Australia treats violations seriously.

Safeguards against professional boundary violations for practitioners include always being alert to ensure professional boundaries are maintained.

If any signs of a possible transgression are identified, it’s important to take a step back to reflect and reaffirm the boundary and to seek support from senior colleagues, management or professional association.

Safeguards against professional boundary violations for clinics may include a clear policy on maintaining professional boundaries, regular meetings between staff to discuss boundaries and any ‘near misses’, mandatory annual training for staff and training as part of an induction for new staff.