Maintaining your boundaries

Physiotherapists and support workers spend numerous hours treating patients; some for a handful of sessions, some spanning months or even years. 

We build connections and relationships with our patients, their families and carers to establish trust and work collaboratively, however it is our duty to keep these relationships professional. People will have their own unique set of boundaries dependent on culture, experiences and values and it is your job to be aware of these and negotiate them safely. Breaching professional boundaries can cause significant harm to patients and can damage a person’s and the profession’s reputation.

Developing an emotional attachment to a patient can impair your professional judgement. Despite working collaboratively with patients there can still be an imbalance of power - patients may be vulnerable through their need for healthcare, and physiotherapy staff have the knowledge and resources patients need. Professional boundaries protect both therapists and patients; it is vital that we evaluate relationships and ensure boundaries are maintained.  

Being friendly with patients is a huge part of healthcare and lots of us use humour and storytelling to make treatments more engaging. What happens though when the conversations steer into personal matters? What if you have common interests and your patient suggests you join their sports team? These situations are quite common, and there is no absolute right or wrong answer.

Instead, it comes down to professional judgement and exercising your own reasoning for each situation. If you are discussing personal matters and common interests which aids the therapeutic relationship, be mindful, however this can often be beneficial.  Or, has your conversation turned to matters of a sexual nature or even political views? Try to redirect the conversation back to the clinical matter in hand, even explaining professional boundaries set out by your health care regulation. If needed, look to transferring their care to a colleague.   

Acceptable social activities 

So what happens if patients wish to involve you in social activities? Consider the type of activity they are suggesting, along with the potential professional implications, conflicts of interest and the previous imbalance of power. For example, being invited to a large wedding reception versus a small family meal, or playing one to one contact sport versus joining a wider sports team. Be mindful of your conversations in these social environments and maintaining confidentiality, plus the issues with offering advice and duty of care. 

Another area of potential conflict is social media, with the HCPC affirming you must use all forms of communication appropriately and responsibly. Both the HCPC and the CSP have guidance on the use of social media, but we do advise to decline online friend requests. An informal online relationship with a patient could put you at risk of breaching your professional responsibilities.   

Breaching boundaries

Intimate relationships, with current patients and their families or carers, whether emotional or sexual, are a breach of professional boundaries, according to the HCPC. There is no clear guidance given as to when a relationship with an ex-patient or carer is or isn’t appropriate.

If you feel boundaries are not being maintained, inform your line manager and ask to transfer care to another colleague. If you are a sole practitioner this can be difficult, but you should not continue to treat a patient where you have identified an unmanageable risk to your professional boundaries.  

Reflect on the situation

If you are considering a relationship with a former patient, or their family member or carer, it is important to consider the impact on your own professional status, and any future harm that could be caused. Also consider other factors, such as any ongoing vulnerability or continued emotional reliance on you, the duration of treatment, and the length of time since the professional relationship ended.

There are many examples of romantic relationships between physiotherapists and ex-patients being successful, however there are also situations where patients are unintentionally harmed and HCPC reports are made. We must use self-awareness and knowledge of each individual, as well as understanding our own professional duty, to establish professional boundaries and ensure we remain within them.