Members should refrain from providing services to a person with whom they have a close personal relationship, such as a family member, friend, relative, or business partner, except in an emergency or if there is no other option available for the required service.
The practitioner-patient relationship involves a power imbalance in favour of the practitioner. This is why it is not recommended for the practitioner to treat other members of their family, as the practitioner will likely be unable to discharge their fiduciary duty in light of the emotional connection to the patient.
Members must never treat a spouse or a person with whom they have a sexual relationship, except in an emergency.
Can practitioners provide treatment to acquaintances (e.g., friend of a friend or a spouse of a relative, etc.)?
While treating an acquaintance may be acceptable under certain circumstances, practitioners need to be mindful of possible dual relationships. A dual relationship is where the patient has an additional relationship with the practitioner other than just as a patient (e.g., where the patient is a relative of the practitioner). Any dual relationship has the potential for the other relationship to interfere with the professional one.
It is best to avoid dual relationships whenever possible. The rationale for this is that members of the profession must always place the interest of the patient before their own. By taking the step to avoid dual relationships, members ideally will mitigate the risk of being placed in a situation where they may be motivated by other interests over the genuine health care needs of their patient.
Giving and receiving gifts can be potentially risky to the practitioner-patient relationship, as it may be considered a boundary violation. In some circumstances, for example, a gift that is of significant monetary value could lead the patient to believe a personal relationship is being formed with the practitioner. Practitioners should be careful about accepting gifts from patients in general. However, there are some situations in which it may be acceptable to do so, for example, when a patient brings a small New Year’s gift to their December appointment (gifts of nominal value where the financial value is small).
Practitioners must also be sensitive to the patient’s culture, where in some situations, refusing a gift could be considered an insult.
Maintaining professional boundaries is about being reasonable in a specific situation or context. It can be a delicate balance between maintaining a suitable professional distance and being engaged with the patient.
Practitioners should be mindful of accepting "friend" requests from patients on personal social media accounts. A practitioner must be careful to act as a professional health care provider, and not as a friend, to patients. Becoming too personal or too familiar with a patient is confusing to patients and will make them feel uncomfortable.
Practitioners may want to consider having a professional social media account that is separate from their personal account.
Whenever something occurs that could lead to a boundary violation, practitioners need to quickly address it. This may mean that a practitioner has a conversation with the patient to explain that dating a current patient is inappropriate and unprofessional.
However, there may be instances where a member finds that professional boundaries cannot be maintained. Practitioners must take these steps to end the patient-practitioner relationship:
1. Provide notice to the patient of the decision.
2.Help the patient find another practitioner.
3. Explain the fees for providing the patient with a copy of their record or transferring a copy to their new practitioner.
Dating former patients is a sensitive issue. Under the Health Professions Procedural Code, practitioners must not engage in sexual relations with a patient or engage in sexual behaviour or make remarks of a sexual nature towards patients. The Code requires that a one-year cooling off period between the termination of the professional relationship and when a sexual relationship can begin.
After the one-year period, it is not sexual abuse because the person is no longer the practitioner’s patient. However, it can still be unprofessional where the practitioner still has power over the patient even after a year has passed. Again, the rationale behind this concept is that members of the profession must always place the interests of their patient before their own.
Practitioners have a legal duty as a regulated health professional to report certain information about yourself and/or your practice to your regulatory College.
In some situations, you have a duty to report other regulated health practitioners to their professional colleges or to an appropriate authority. For example, you are working in a multidisciplinary clinic and have reason to believe that another regulated health professional has sexually abused a patient. In that case, you must file a written report to the Registrar of the college that regulates that professional.
This is called mandatory reporting. By doing your duty to report, you help the College meet its mandate to protect the public. You also help maintain the integrity of the profession.
For more information on Mandatory Reporting Requirements, please refer to the College’s Educational Tip.
For a regulated health profession to obtain an exemption, they need to submit a regulation amendment to the Ministry of Health. The Ontario Government will then consider whether to grant the exemption or not.
Sometimes patients ask questions about my personal life (e.g., marital status, if I have children, etc.). What do I need to consider before responding?
Practitioner’s need to consider the potential risks of self-disclosure (pg. 21 of the Jurisprudence Couse Handbook explains):
“When a practitioner shares personal details about his or her private life, it can confuse patients. Patients might assume that the practitioner wants to have more than a professional relationship. Self-disclosure suggests that the professional relationship is serving a personal need for the practitioner rather than serving the patient’s best interests. Self-disclosure can result in the practitioner becoming dependent on the patient to serve the practitioner’s own emotional needs, which is damaging to the relationship.”
The responsibility for setting boundaries in the patient-practitioner relationship rests with the member. Each patient’s boundaries will be unique to their own experiences, including their culture, gender, age, beliefs, values, and sexual identity. However, it would be up to the practitioner’s discretion what they wish to disclose to their patients regarding their personal life.
Depending on the situation that arises, this may mean that a practitioner has this conversation early on with their patient, to establish that they do not discuss with patients their personal information. Practitioners may need to remind their patients of this (in a nice and respectful manner), so that they are clear on what the boundaries are.
What are specific boundary considerations with respect to telepractice, including the use of text messaging?
Telepractice may provide opportunities for more informal types of interaction, which may lead to potential boundary crossings. For example, suppose a practitioner allows for text messaging with patients. In that case, they should carefully consider their expectations of how and when they will use and respond to text messages from their patients. Members will also want to remember and consider how these text messages are incorporated into the patient record.
Practitioners should also pay attention to the environment where telepractice will occur and avoid any personal items that may increase the risk for boundary crossings or violations.
Members can refer to the Telepractice Guideline for more information.
Sometimes I have patients that disclose mental health information. Are there any resources I can provide?
Patients may not be aware that the diagnosis of mental health conditions is a controlled act that is not authorized to members of the College. Practitioners would need to explain that counselling/therapy is outside of the scope of TCM practice. While treatment of and diagnosis of mental health conditions is a controlled act, the practice of traditional Chinese medicine involves the assessment of body system disorders through traditional Chinese medicine techniques. As such, practitioners may, under certain circumstances be able to alleviate symptoms of anxiety, depression and stress through traditional Chinese medicine therapies to restore balance to the body system.
As with any treatment provision, members must follow the Standards of Practice, guidelines, and ensure that they have the competencies (knowledge, skill and judgment) to provide safe and effective care to their patients.
Some online resources are included below that may provide patients with additional information for further support:
If the patient would like to see a regulated health professional for mental health (e.g., family doctor, psychiatrist, psychologist, etc.), the Health Professions Regulators of Ontario (HPRO) website has a list of the regulatory bodies. All the colleges have a public register for member lookup.