Four Critical Professional Boundaries at Medical Practices

Definite boundaries are essential to constructive interpersonal relationships. The concept is widely misunderstood in medical offices, and the value of appropriate boundaries seems to be best realized in their absence.

Here are four boundaries your physicians and staff should follow:

Authority in the service of responsibility
Psychological boundaries between a physician and her staff serve to maintain the physician’s recognized authority to issue directives and make decisions. They are absolutely essential for that purpose. 

An often-missed distinction is that the physician's authority is properly guarded in the service of her responsibility to patients and to the practice. As the person with the moral, legal, and economic responsibility for the consequences of decisions and outcomes, she must be recognized as the ultimate decision-maker.

Not authority in the service of ego
Boundaries that support the physician as a superior being are not constructive.

Physicians should generally refrain from making copies and turning rooms because it is not the best use of their time - not because the work is beneath them. In unusual circumstances in a healthy environment, a physician will jump in and help with menial tasks because, at that moment, it is the best use of his time for the good of patients or the practice. Rather than diminishing his authority, the behavior, rooted in responsibility, enhances the physician's legitimate authority.

Not all pertinent knowledge resides with the physician
Boundaries that respect the expertise of staff yield multiple benefits.

Physicians have significant gaps in their knowledge of what goes on in their offices because they are generally cloistered in exam rooms or at the hospital. Allowing staff to take the lead in solving operational issues not only elicits information otherwise unavailable to the physician, it gives staff an opportunity to assume some responsibility for the service of patients and the good of the practice. Even the most enthusiastic autocrat can get weary and appreciate sharing at least some of the load.

The behavior is a delegation, not an abdication, of the physician's authority. It is OK if a proposed solution conflicts with a requirement outside of staff's scope of knowledge. It gives the physician an opportunity to expand staff's knowledge, and reinforces his expert authority.

Personal Boundaries
Physicians must maintain personal boundaries with staff.

It can be hard to avoid regarding one another as friends. You spend a lot of time together and share experiences. You rely upon and respect one another. That can feel like friendship.

The relationship is, or should be, based upon the needs of the practice, not mutual personal interests and congeniality.  There is significant disparity in the power of the parties to the relationship. That is not friendship, no matter how congenial.

Bosses critique staff job performance and recommend opportunities for correction and improvement. They issue orders. Good bosses are sympathetic to employees' emotional needs, as well as time and money constraints, but their focus is on what the business needs. Bosses always win in disputes that cannot reach complete mutual agreement. If staff's expectation is that the physician is their friend, they will find it difficult to tolerate the boss' behavior, and the boss' job will be more difficult.

One of the most typical ways to mislead staff into thinking they are friends is to discuss personal problems. General conversation about common experiences with children and family is fine, but it is never a good idea to confide in staff.

Be friendly. Be human. Be considerate. Have friends outside of the office.

Well-defined and observed boundaries are necessary and useful to the effective and congenial operation of a medical office.