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Respecting boundaries

Staying on side

Preventing boundary issues

Finger drawing a line in the sandAn important aspect of prevention is recognizing which situations may cross a boundary. Because trivial boundary crossings may lead to more serious boundary violations such as sexual contact, it is important to be aware of non-sexual boundary issues. Here are some strategies to consider:
  • Give clear, timely explanations of:
    • the reason for taking a history or doing an examination
    • the nature of the examination
  • Ensure that sexual histories are:
    • relevant to the clinical situation
    • performed in a sensitive manner
  • Ensure touching will not be misinterpreted.
  • Use a chaperone during intimate exams.
  • Respect the patient's right to privacy:
    • provide appropriate draping
    • leave the room when the patient changes clothes
  • Look for early signs of emotional involvement (yours and your patient's).
  • See patients only in medically appropriate settings.
  • Be cautious of social contact outside the office or hospital.
  • Be knowledgeable about gender, cultural, and ethnic sensitivities.
  • Be alert to possible misunderstandings.
  • Ask yourself what a neutral outsider would say if observing your conduct.

Medical students should consider speaking with a supervisor or mentor if involved in an actual or potential boundary issue.

While students cannot be the subject of complaints to a medical regulatory authority (College)
Regulatory authority, professional:  Licensing body for a profession.
Provincial/territorial medical regulatory authority (College)
Body that regulates the practice of medicine in each province or territory to ensure the public receives quality medical care from physicians. The responsibilities include:
- Issuance of certificates of registration to allow the practice of medicine,
- Maintenance of standards of practice,
- Investigation of complaints against physicians, and
- Remedial education or discipline for those guilty of professional misconduct or incompetence.
The medical profession is self-regulating in Canada. Each authority has an investigative process and committee structure to make decisions on different issues and complaints.
, boundary crossings and violations by students can be reported to their educational institution or hospital, and may be disciplined for inappropriate behaviour.