D2. You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

  1. Abuse of your professional standing can take many forms. The most serious abuse of your professional standing is likely to be the failure to establish and maintain appropriate boundaries, whether sexual or otherwise.
  2. Appropriate professional boundaries are essential for trust and an effective therapeutic relationship between osteopath and patient. Professional boundaries may include physical boundaries, emotional boundaries and sexual boundaries. Failure to establish and maintain sexual boundaries may, in particular, have a profoundly damaging effect on the patient, is likely to bring the profession into disrepute and could lead to your removal from the GOsC Register.
  3. Not all crossing of professional boundaries will necessarily be an abuse of your professional standing. For example, sometimes it may support empathy and trust with a patient to disclose personal information or to treat a patient as an emergency outside your usual hours. However, there is a spectrum, and osteopaths must ensure that patients who may be vulnerable are protected at the time and throughout the duration of the professional relationship.
  4. You should be aware of the risks to patients and to yourself of engaging in or developing social or commercial relationships with patients, and the challenges which this might present for the therapeutic relationship and to the expectations of both patient and professional. You should also be aware of the risk of patients developing an inappropriate dependency upon you, and be able to manage these situations appropriately, seeking advice from a colleague or professional body as necessary.
  5. When establishing and maintaining sexual boundaries, you should bear in mind the following:
    1. words and behaviour, as well as more overt acts, may be sexualised, or regarded as such by the patient. Examples might include:
      1. sharing inappropriate intimate details about yourself
      2. visiting a patient’s home without an appointment
      3. making inappropriate sexual remarks to or about patients
      4. unnecessary physical contact.
    2. You should avoid any behaviour which may be construed by a patient as inviting a sexual relationship or response.
    3. Physical contact for which valid consent has not been given can amount to an assault, leading to criminal liability.
    4. It is your responsibility not to act on feelings of sexual attraction to or from patients.
    5. If you are sexually attracted to a patient or if a patient displays sexualised behaviour towards you, you should seek advice from, for example, a colleague or professional body on the most appropriate course of action. If you believe that you cannot remain objective and professional or that it is not possible to re-establish a professional relationship, you should refer your patient to another healthcare practitioner. If referring a patient because of your own sexual feelings towards them, you should endeavour to do so in a way that does not make the patient feel that they have done anything wrong.
    6. You must not take advantage of your professional standing to initiate a personal relationship with a patient. This applies even when the patient is no longer in your care, as any personal relationship may be influenced by the previous professional relationship and an imbalance of power between the parties.
    7. You must not end a professional relationship with a patient solely to pursue a personal relationship with them.
    8. If you think that a personal relationship with a former patient might develop, you must consider whether this is appropriate. Factors that might impact on this include:
      1. the nature of the previous professional relationship
      2. the length of time the professional relationship lasted, and when it ended
      3. whether the former patient was particularly vulnerable at the time of the professional relationship, and whether they might still be vulnerable.
    9. Osteopaths who practise in small communities may find themselves treating friends or family. In such cases, establishing and maintaining clear professional boundaries will help you ensure that your clinical judgement is objective and that you can provide the treatment your patients need. The same level of care should be given to all patients, whether you know them in a social or other capacity, or not.