Navigating professional boundaries

Dr Victoria Cox and Dr Ellen Walshe write that while professionalism might be easy to define in theory, it can be more complicated in practice

Consider this scenario: Dr O, an early career GP, had been treating Ms T for a chronic condition and they had built up a rapport. He noticed she often seemed anxious about her symptoms between appointments and, wanting to be helpful, told her she could message him on his personal phone if anything urgent came up and she wanted to discuss things.

Over the next few weeks, the messages became frequent and some late at night. Others included photos of symptoms. Dr O responded each time, but soon started to feel responsible for Ms T’s wellbeing. He also felt uncomfortable giving clinical advice without oversight and access to records.

When a senior colleague learned what was happening, they explained that sharing personal contact details with patients blurred boundaries and exposed both doctor and patient to risk. Dr O arranged for her care to be managed through the practice’s official channels and reflected on how easily a well‑intentioned gesture had slipped into unsafe territory.

Professionalism

‘Professionalism’ lies at the heart of safe medical practice and underpins the trust that patients place in their doctors. The Medical Council, in its Guide to Professional Conduct and Ethics for Registered Medical Practitioners (the ‘Guide’), frames professionalism as a set of core values expressed through behaviours that justify the trust placed in doctors by patients and by society.

Professionalism might be easy to define in theory, but can become a lot more complicated in practice. We receive many calls to the Medical Protection advice line from members seeking advice on how to navigate dilemmas where professional boundaries could become blurred or already have.

Probity

Probity is also a key area and directly concerns honesty, integrity, and the trustworthiness of a clinician. It is central to the public trust placed on the medical profession.

Most clinicians would never intentionally bring the profession into disrepute or undermine public confidence in it. However, unfortunately, with ever-increasing demands on medical professionals both in and outside the work environment these boundaries can be easily forgotten or become blurred. This can result in doctors finding themselves at the centre of a regulatory or disciplinary process.

Medical professionals who work independently, for example, in private practice or as a single-handed GP, may find themselves more vulnerable due to a lack of informal safeguards. Having people around you can often help to enforce the importance of clinical and social boundaries. Those working under extreme pressure or in emotionally charged clinical situations may also find it difficult in the heat of the moment to remember their professional responsibilities towards their colleagues or patients.

Health professionals as role models

The Medical Council is clear that professionalism applies both in and outside of work. How a senior clinician speaks to patients or colleagues on a ward round or during a consultation can have a considerable impact on those observing their actions. While treating patients with respect and without prejudice may seem an obvious example of professionalism, it can be easy to forget that off-the-cuff comments made during a coffee break or on a WhatsApp group could be deemed unprofessional by a regulatory body.

Often it is the actions of a clinician outside of work that result in concerns or complaints being raised with the regulator. Emotive reactions to political or social situations on social media, interactions with patients when ‘off duty’, and the seemingly innocent prescribing of medication for a family member are but a few examples that can result in a referral to the Medical Council.

Being a medical professional in essence starts from the moment you wake up in the morning – how you conduct yourself with your family, how you drive to work, your timekeeping and appearance, the relationships you build both in work and socially, and even the way you act on holiday. All of the above are examples of situations in which a clinician’s actions or behaviour have resulted in a case being brought before the regulator.

It can often appear unfair that the actions of a doctor away from the work environment are still held to account, where, in other professions, this may not be the case. However, conversely some may see professionalism as a contract that healthcare professionals should always fulfil with the reward being the trust of their patients and the respect of the general public.

It is important to remember that professionalism is not about trying to remember or learn the contents of the Guide. It is about medical professionals familiarising themselves with the key concepts and applying the standards relevant to an individual’s knowledge, skills, and experience, applied in context.

Rather than focusing on rules and standards, it is important for a medical professional to develop the skills to be able to take a step back and think through a situation calmly, while being able to communicate clearly and professionally. This can take skill and strength, but getting it right can protect both patients and clinicians.

Continued learning

Ongoing learning can help us to recognise those ‘grey’ moments before they become a problem.

Medical

Protection members can access the professionalism course on The Learning Hub at no extra charge, as a benefit of membership. This interactive online course looks at how small, everyday behaviours can affect trust, consent, and professional relationships, and why boundary issues often arise unintentionally. It also acknowledges the reality of modern practice: Social media, cultural differences, global patient expectations, and working across teams and settings.

Rather than focusing only on rules, the course gives clinicians practical ways to think through difficult situations and communicate clearly and professionally.

Members can access the course any time by logging into The Learning Hub: https://prism.medicalprotection.org/