Professional boundaries case studies - professional boundaries

Case 1

You are an Advanced term Registrar and very competent, very confident and need
little supervision. The staff think the world of you and regard you as the best
Sandra works as a receptionist in the Practice. She does al the scanning of correspondence for the computer. With 12 doctors, the Practice is very busy and there is a lot of scanning to be done every day. Sandra has recently developed bilateral shoulder pain, which she believes is due to the extensive amount of document scanning she does every day. She makes an appointment to consult you about it. You check your list of patients for the afternoon and notice Sandra has made an appointment to see you.
You are unsure how you should approach this matter and ask to
discuss this with your Supervisor. What are the pertinent points for you
to consider?

You have also been requested to see Peter, Ann’s husband. Ann is one of the
partners in the Practice. Peter is a businessman who travels a lot and does not
have a regular GP. You feel uncomfortable about seeing Peter, and decline to see him. Ann is somewhat upset. Al Peter needs is some travel advice and Ann thinks
you are competent at it. You feel pressured to see him.

Again you are unsure how you should approach this matter and ask to
discuss this with your Supervisor. What are the issues you need to
consider?
Case 2

Sam is an 82 year old with lung cancer. He is well known to the Practice where
you work. His wife Sarah is also a regular patient at the Practice and has attended
You are a sensitive and caring Basic term Registrar who has just completed a palliative care rotation at one of the public hospitals. You spend a lot of time with Sam and are involved in his pal iative care. You do frequent house cal s and were Sarah consults you a week after Sam died. She is grieving for his loss. She brings with her a gift on behalf of Sam for you. It is a case of a dozen Grange wine valued at $12,000. Sam was a great wine col ector and connoisseur. He knew that you appreciated good wines and his death wish was to leave it for you.
You inform your Supervisor of the situation. What are the issues you
need to consider, if any?

Case 3

Jan is an Advanced term older Registrar who has a smal child aged 2 years old.
She is an IMG and was a physician in China. She does not have a GP herself. She is very conscientious and does not like to be absent from work. She readily accepts to do the late rosters whenever asked. She has had a cough for 6 weeks and stops you (a Basic term Registrar in the Practice) in the corridor and requests a prescription for antibiotics (she knows it is not best practice to self prescribe). She tel s you that she usual y takes Keflex and this clears it for her. She does not wish to take time off to consult anyone else outside the Practice.
Is it appropriate for you to abide by her request?
What are the issues to consider?
Case 4
You are an attractive young Registrar who is very popular. You have completed
your Mental Health Level 1 Training Course at one of the weekend educational sessions offered by the Col ege. Chris is a 40 year old patient with anger management problems who is having difficulty with his marriage and is feeling both anxious and depressed about his You have seen him regularly in the last couple of months and Chris is making progress with the counseling sessions he is having with you. At the last consultation he felt so good after a particularly good counseling session that he gave you a kiss on the cheek. You felt uncomfortable about it but were sure it had no sexual innuendo. However you confide in your Supervisor and tel him/her what happened. Chris is due to see you again for a fol ow up appointment in a couple of days and you are unsure what to do.
What are the issues to consider?
Case 5
You are a Subsequent term Registrar. Peter consults you with a rash on his penis,
which has been troubling him for a couple of weeks. Al the senior doctors in the practice are ful y booked and Peter is very distressed by his symptoms and requests urgent attention. You take a history and ask him to take his pants off so you can examine him. You draw the curtain around the couch and give him time and privacy to undress. When you go to examine him, you find that he has an erection. You leave the room distressed and tel Peter that you do not wish to see him. You are standing in the corridor. What are your options?
Case 6

You are doing your rural term and feeling lonely and missing your family. Since your
arrival to town, Pam, a middle aged woman has been attending you regularly for menopausal symptoms and tiredness. She thinks highly of your care, especial y since you diagnosed her with hypothyroidism as a cause of her tiredness. Since you have disclosed to her that you are in the town on your own, Pam decides to take you under her wing. She invites you to have dinner with her in her home and meet her friends from the book club.

Should you accept?

You accept the invitation. After dinner, Pam has a migraine attack and asks you for
a Pethidine injection as it is the only medicine that works for her pain. You have
your doctor’s bag in your car. You happen to be carrying an ampoule of Pethidine.
How could you respond to Pam’s request?
Case 7
Amira is an IMG in the Practice in which you work. She is from a conservative
Muslim background. In general she is shy and reserved. Recently the staff noted that she rings up sick frequently. You note that her absenteeism coincides with the roster of Rob one of the senior partners in the Practice. Rob is an easy going, humourous person, fond of jokes.
You take the opportunity to talk to Amira when she is next in.
What do you think may be causing her frequent absenteeism?

When talking to Amira you find out that she is unhappy with the behaviour of Rob
towards her. She feels offended by the type of jokes and “passes” he makes at
her. She is too shy to confront him about it.
What is your approach?
Case 8

Moustafa is a 45 year old IMG with a young family of 4 children in his Advanced
term. You are a Basic term Registrar in the same Practice. Moustafa comes highly
recommended from the previous Practice, as an empathic and knowledgeable Registrar despite having sat the FRACGP exam twice and failed. The Practice staff have noticed that he is always tired when he comes to work. Patients have reported that he sometimes fal s asleep during consultations. Further, unlike other Registrars, he never attends Practice social “get togethers” and stays in his consulting room during lunch breaks.
What do you think might be going on with Moustafa?

Later you find out that he is working in another surgery, doing long evening shifts,
in order to make ends meet. He did not disclose this to the Practice as he was
worried they may not employ him. You are becoming worried about him as your col eague.
What is your approach?

When talking with Moustafa he strikes you with his flat affect and his general
disinterest. His failure at FRACGP and the financial burden of his family weigh
heavily on him. He has lost confidence in himself. The adverse media on IMGs makes him feel devalued.
What is your approach now?

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