■ Professionalism and ethics:

Integrating professional duties, societal expectations and personal wellbeing

Respecting boundaries: Grateful patient

Type of activity: Video

Activity summary

The short video "Grateful patient" portrays a series of interactions between a patient and medical student that embody the "slippery slope." The facilitation questions and suggestions to faculty focus on helping learners to recognize the importance of maintaining boundaries and how they may be inadvertently crossed by a medical provider.

Transcript

Setting: Physical rehabilitation ward bed with two characters.

Student: Hi Mr. Reilly. How are you feeling today?

Mr. Reilly: Not too badly. I really wish I didn't have to be in here. I miss my home. My kids live too far away to visit me... You remind me of my granddaughter.

Student: Really. What does your granddaughter do?

Mr. Reilly: Oh - she wants to be an architect. I have two other children but I don't get to see them very often. May I call you Mary?

Student: Sure.

Mr. Reilly: Ah good. Well, tell me a little bit about your family Nan... uh Mary.

Student: Well, actually one of my sisters is actually an architect too. I decided to go into medicine because I enjoy working with people. I have four siblings, four brothers and sisters and they all live near my parents' farm. My parents can't help me much with my education. I miss them a lot when I'm in school. I can't afford to go back home too often.

Mr. Reilly: So money's rather tight. Your parents are so lucky to have many children. I'm sure your father misses you too.

Student: I certainly miss him a lot. (Beeper goers off and she checks it) I have to go. I'll come back at the end of my day and we can take a look at your album.(pointing)

(Student and Mr. Reilly looking at photos together, both smiling.)

(Two weeks later: Mr. Reilly is sitting reading a book by the bed, in street clothes.)

Student: Good morning, Mr. Reilly.

Mr. Reilly: Ah, Mary.

Student: I've got some good news for you. You're doing so well; Dr. Smith says you can leave tomorrow.

Mr. Reilly: Oh, that is really great news.

Student: I'm really happy for you though I will miss our little chats. Do you have anybody picking you up tomorrow?

Mr. Reilly: No, I'm alone. I'll take a taxi.

Student: I could drive you home tomorrow after my day. They're calling for a storm on the weather forecast.

Mr. Reilly: Thank you so much for all the care and attention you have given me. I've been waiting for this moment. (reaches for envelope from table by bed) I have a little something for you.

Student : Oh, thank you. (opening and envelope) Oh, but no, this is a cheque.

Mr. Reilly: That should take care of all your student debts. You are going to be a wonderful doctor.

Concluding facilitation question: What boundary issues did you identify?

Facilitation questions

  1. How should the medical student respond?
  2. Describe how the slippery slope may apply to this scenario.
  3. How should the medical student document this encounter?

Suggestions to faculty

This video may also be used to explore "Physician-patient: Patient-centred communication"CMPA Good practices. For example, have learners role play the medical student declining the patient's gift. What are key considerations for a healthcare provider during this type of conversation?

Additional resources

CanMEDS: Professional

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.