Doctor Patient Relationship

Doctor of Physiotherapy
Lecture 2
Subject: Behavioral Sciences

Prepared By
Ms Zahra Ejaz Alimirza
Clinical Psychologist
 Doctor Patient Relationship
• Professional boundaries are parameters that
describe the limits of a relationship in which one
person entrusts their welfare to another and to
whom a fee is paid for the provision of a service
• Boundary issues include:
• Boundary crossings, which are departures from
usual professional practice that are not
exploitative. On occasion, a boundary may be
consciously crossed with the intention of actually
assisting a patient’s management
• Boundary violations are transgressions, which
harm the patient in some way.
• Boundary violations are unethical and
unprofessional because they exploit the doctor–
patient relationship, undermine the trust that
patients and the community have in their
doctors, and can cause profound psychological
harm to patients and compromise their ongoing
medical care.
• Good medical practice relies on trust between
doctors and patients and their families.
 Sexual misconduct
• Sexual misconduct covers a range of
inappropriate behaviors including:
• Sexualized behavior such as any words or actions
that might reasonably be interpreted as being
designed or intended to arouse or gratify sexual
desire
• Sexual exploitation or abuse, which includes
sexual harassment
• Sexual assault, which ranges from physical
touching (or examination without consent) to
rape, is a criminal offence
 Doctors’ Psychological risk factors

• When doctors are under stress themselves, with

insufficient emotional support, boundaries are more
likely to be crossed and violated.
• Inexperienced doctors may also be naïve to the
complex and problematic effects of boundary
crossings.
Rarely, some doctors may be suffering from a mental
illness, such as mania, which results in disinherited
behavior.
• There are also a small number of predatory doctors
with personality disorders who actively prey on
patients.
• Poor communication can also result in
complaints that a doctor’s actions were
inappropriate and/or sexually motivated.
• In these cases, the consultation and
examination are appropriate and clinically
indicated, but the doctor has not explained,
and/or the patient has not understood why
the doctor has asked a particular question or
performed a particular examination.
 Anger Issues
• If a doctor gets angry or getting annoy on any
thing , they should know about their weak
points and should not be out burst in front of
the client
• Aggressive doctors should control their
behaviors
• If you feel that your patient can be irritate you
in future then do not consider the client
recommend him in other good doctors
 Transference
• Redirection of a client’s feelings from a
significant person to a therapist.
• Transference is often manifested as an
attraction towards a therapist, but can be
seen in many other forms such as mistrust,
extreme dependence or even placing the
therapist in a god like or guru status.
• The transference between patient and
therapist happens on an unconscious level.
 Counter-Transference
• Counter-transference is defined as redirection of
a therapist’s feelings toward a client.
• It’s a therapist’s emotional endulgment with a
client.
• Relationship is a two way process.
• Doctor has also unconscious tendency to transfer
out the client
• As in case of transference, these counter
transference feelings,, both positive and negative
are unconscious but operate with force.
• Therefore, it is the job of case worker to
recognize his feelings and must control them.
 Summary of the Topic
• Doctors should not be biased with their clients
• Do not get aggressive with the clients
• Understand the client humbly
• Do not degrade the client with their low
symptoms
• Do not get greedy or selfish
• Respect the client
• Always sit with client on a table distance
• Do not share the data of client with others
(Privacy maintain always)
• Do not indulge in the activities with client which are not allowed
ethically
• Room should be appropriate so the client can feel comfortable
• Your body posture should be attentive, and eye contact should be
maintained so client can not feel un comfortable
• You should be welcoming always with your client
• Never receive or give the gifts to the client
• Always fix the amount of fees which you want to charge, do not
charge extra.
• Be careful when deal with the opposite gender
• Informed consent should be signed between therapist and the
client