Patients or Friends—Does it Have to Be One or the Other?

Your patient asks you to play on her softball team. There’s nothing romantic and you have lots of common interests and a couple of common friends. Should you join the team? I’ve written in my blog about boundaries before—we are pretty clear that dating patients is a problem and that sexual relationships are forbidden. But what about when patients become friends? What are the boundaries then?

I’m not going to tell you that there is a clear answer to this question. This is one of those situations that highlights what sets professionals apart from other sorts of workers. The clerk at the local hardware store does not need to second guess whether it is appropriate to become friends with a customer, but a healthcare provider does: therapeutic relationships entail a level of trust, power and closeness that don’t arise in other situations.

There are at least three reasons you need to be careful. You must be able to remain objective about your patients’ care. You have an obligation to put your patients’ needs ahead of your own, which includes avoiding conflicts of interest. And you have to protect your patients from harm—physical, mental, financial—any possible harm, as much as you can. When your relationships with your patients become too close, it can be difficult to maintain your professional perspective.

I asked Shari Hughes how she would explain this issue. Shari is a PT, Associate Registrar and wise advisor and she said that, “a PT gets to see the patient undressed, gets to ask lots of personal questions (but doesn’t have to answer any) and has control over whether the person gets to go back to work or sport (just to name a few). I think it’s natural to try to equalize that differential by the PT sharing stuff about themselves or by the patient offering their accounting expertise at tax time. I think friendship with a patient is a possibility. However, I think the greater likelihood is for the patient to misunderstand a kindness and to potentially be harmed or for the PT to lose his or her objectivity and for the patient to be harmed.

So, you join the softball team. Now your patient is asking for your advice about her aching Achilles at a game. She trusts your therapeutic skills. Do you give her advice? If you do, are you insured? Do you charge for the advice? Wait a minute—did you do a full assessment or did you make clinically inappropriate assumptions based on the casual environment? Maybe there is something in her history, unconnected to the ball game that led to the problem. You missed it because you were offering advice outside your usual clinic setting. And you were in that position because you were friends. It gets even more complicated if she is a WSIB patient—can you be objective about evaluating her work readiness?

In another example, several of your patients are your Facebook friends. You share a post about your sister’s direct marketing business that sells health and beauty supplements. Your patients take this post as clinical advice and buy things they otherwise never would. After all, they trust your judgement about health-related things. But your sister makes money off of your patients and that could be a conflict of interest for you.

Our best advice? Use your good judgement, but it’s probably safest to avoid all personal relationships with patients.

If you are in a small community, this will be nearly impossible and we understand that. In your case, you will have to take special care to ensure that you do everything you can to remain objective, put your patients’ needs first, and to protect them from harm.

I’ll let Shari have the final word, “I wonder whether what we are talking about is treating everyone the same so that the likelihood they’ll misunderstand or be hurt or taken advantage of (whether intentional or accidental) is lower? And by treating everyone the same I don’t mean EXACTLY the same, but within the same general limits or boundaries. I guess you could call it keeping appropriate patient-specific professional distance. For example, the prim and proper 86-year old Mrs. Smith will always be “Mrs. Smith” but the 17 year old skateboarder can be “dude” (do they still make skateboards?) And maybe it’s okay to go to Sally’s first violin recital after her wrist fracture rehab, but you definitely wouldn’t accept Johnny’s mom’s invitation for dinner…”

7 thoughts on “Patients or Friends—Does it Have to Be One or the Other?

  1. Thank you for making our social world even smaller and the bubble in which you prefer we live in even larger.

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    • I have been a PT over 20 years and I do not consider my job and my patients part of my ‘social world’. Have I developed friendships with patients I treated at some point in time? Yes – but I stopped being their PT. I did not become a PT to enhance my social circles.

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  2. This is a silly question. Can you be friends and still an objective medical professional? Absolutely.
    Would any sort of legal issue occur-exceedingly unlikely. Why?
    First, if you EVER want ANY medical care in a small town, then you will need to accept that this is a given. Any medical professional cannot be expected to be a social isolate in a small town, where the population numbers in the hundreds. Maybe in Toronto, where these kinds of issues are thought up, would this be possible. In a town of 300 people, either you would have people be friends AND patients, or medical professionals will never go to these locations to practice, which is ALREADY an issue.
    Second, I think you overestimate our importance as PT’s. We aren’t doing critical heart or brain surgery. We aren’t likely to be so over or under cautious as to do anything that will kill a patient. And if you are, you are incompetent and shouldn’t be in practice at all…with anyone.
    Third, if a friend asks for me to treat them, I do. If I don’t, am I not discriminating against them in a way? If I am the best PT to care for them (I have a special interest in spine) then why would I pass them off to someone who isn’t as good at that area? And what happened to patient choice? If they choose to see me, that is THEIR choice. No one has the right to take that choice away.
    The exact same is true for family members.
    In terms of giving advice on the softball team, they are going to get that advice anyway. Same thing on Facebook. These days, everyone is a doctor on Facebook or at social events. I see people who never graduated high school performing spinal manips on people at parties (ie. “cracking their back” by lifting them up from behind and shaking them). I think me telling someone to elevate it and how to wrap it properly will provide them fairly safe advice versus the idiocy they would typically receive. If a PT is worried about it, then don’t give the advice, or preface it by saying ” I haven’t assessed you, so I’m really only guessing at what to do here, but it is an educated guess.”
    There isn’t a PT, doctor, nurse, chiro or anyone else who hasn’t treated friends or family at some point. If you bring it as an issue to one person, you’ll have to condemn us all…
    The College’s purpose is to protect the public…the public is better served by getting good information, even informally, from a reliable source as opposed to getting it from John Q Facebook, which they do all the time.

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  3. next time if i see any of my clients/patients working out in gym i will better walk out and wait for them to leave then come back to continue my wokout

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    • Seriously? This happened a lot to me but I never had to leave the gym because I see my patient(s) exercising. I sometimes pretend I did not see them. When they complain of re-aggravtion of the shoulder issues let’s say, I still ask what happened. The patient may leave the gym but I’m not, especially if I have more exercises to do compared to him / her. I am just practicing what I preach, and I will exercise at a time or day (and wear gym clothes) that is optimal for me. If a patient is anxious of privacy, that is his / her problem.

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  4. This topic is tough for me as a long standing PT in a small community where I treat my doctor, dentist, pastor, lawyer, neighbours, friends etc. I have tried to pass them on to colleagues without success. Sometimes our college “rules” just don’t make sense for those of us living outside Toronto or in an urban setting and I am thankful that our college recognizes this.

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