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Overview of Boundaries, Ethics, and Professionalism

Overview of Boundaries, Ethics, and Professionalism. by Glen O. Gabbard, M.D. Brown Foundation Chair of Psychoanalysis and Professor of Psychiatry Baylor College of Medicine. What is Professionalism?.

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Overview of Boundaries, Ethics, and Professionalism

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  1. Overview of Boundaries, Ethics, and Professionalism byGlen O. Gabbard, M.D.Brown Foundation Chair of PsychoanalysisandProfessor of Psychiatry Baylor College of Medicine

  2. What is Professionalism? The essence of professionalism is to serve the interests of the patient above the professional’s self-interest. Professionalism aspires to altruism, accountability, excellence, duty, honor, integrity, and respect for others.

  3. Professionalism is how you behave with patients and co-workers when no one is watching.

  4. Differences Between Professional and Personal Relationships Adapted from British Columbia Rehabilitation Society, 1992

  5. Differences Between Professional and Personal Relationships (cont.) Adapted from British Columbia Rehabilitation Society, 1992

  6. Unprofessional Behaviors Negligence Exploding in anger at co-workers Boundary violations Dishonesty Sexual harassment Contemptuous behavior towards patients Bullying

  7. Common Boundary Violations Sexual relationships with patients Business transactions/dual relationships Acceptance of large gifts Denigrating or sexually provocative language Barter/Mishandling of fees Misuses of the examination Inappropriate types of physical contact Excessive self-disclosure

  8. Sexual Boundary Violations Egregious and exploitative behaviors that violate the principles of ethical conduct, harm the patient, are often not discussable, and are generally part of a repetitive pattern

  9. Why are Boundary Violations Unethical? Power differential Transference phenomena Impaired ability to give informed consent A ripoff A professional cannot provide objective care when a sexualized relationship exists

  10. 3 CATEGORIES OF SEXUAL MISCONDUCT Sexual impropriety Sexual transgression Sexual violation proper Medical Council of New Zealand 1992

  11. SEXUAL IMPROPRIETY Refers to gestures or expressions disrespectful to the patient’s privacy and sexually demeaning to the patient Many cases of sexual harassment involving unwanted advances, sexually explicit remarks, and denigrating comments would fall under this category.

  12. SEXUAL TRANSGRESSION Involves sexualized and inappropriate touching of the patient that falls short of actual sexual relations Kissing, touching of the breasts or genitals not appropriate for the exam, or performing a physical exam without gloves

  13. SEXUAL VIOLATION PROPER Refers to sexual relations between a professional and a patient It makes no difference who initiates the contact and whether or not love has been professed Oral sex, anal intercourse, genital intercourse, and mutual masturbation

  14. THE SLIPPERY SLOPE PHENOMENON

  15. Place and Space • Hospital • Clinic • Private Office

  16. TIME • Length of appointments • Time of appointments

  17. ACCEPTANCE OF LARGE GIFTS • Expectation of special treatment • Suppression of anger • Unconscious bribe

  18. SELF-DISCLOSURE • Role reversal • Burdening the patient with personal problems or family matters

  19. Clothing • Unprofessional Dress • Sexually Provocative Clothing

  20. Language

  21. Business Transactions • The fundamental problem with dual relationships • Exchange of fee should be the limit

  22. Physical Contact • Handshake is usually limit • Cultural differences • The problem of the hug

  23. MENTALIZATION • The capacity to recognize one’s own perception as subjective and the awareness that another’s perception might be quite different based on that person’s subjectivity. • The capacity to reflect on one’s internal world as fallible and one of only several possible perceptions

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