Setting Boundaries in Health Care

Patient Expert
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We all have a sense of boundaries on what we will accept, and what we can do and say to each other. But when you enter a health care setting, different rules apply and all of a sudden, it can be hard to know where to draw the line.

The angry dermatologist

I’ve been there myself many times over the years. One situation especially stands out as a learning opportunity for me.

I’d been referred to a dermatologist for my annual mole check. When I was shown into the doctor’s office, I very quickly knew something was wrong. He seemed grouchy and there was an edge in how he spoke to his nurse. When part of my wheelchair was blocking him, his angry gesture to get me out of the way sealed the deal. I didn’t say anything—it didn’t feel safe to do so with someone who had that level of anger.

I didn't file a complaint, but did ask my family doctor for a referral to someone else. I also suggested she not refer other patients to the angry doctor.

Empower yourself

The dynamic between health care provider and patient has traditionally been very authoritarian. Whether this is the cringe-inducing idea about being compliant with your doctor’s orders—are you compliant in any other sphere of your life?—or submitting to painful and invasive procedures, the system is designed to step all over your personal boundaries.

This is beginning to change, especially in the chronic illness community where people are becoming empowered to take control of their health. That includes working as a team of equals with health professionals and being the person who makes the decisions. To get started, do some research about the topic and how other people are approaching it. From there, it’s a matter of practicing and gradually getting more and more empowered.

Know where your boundaries are

Enforcing our own personal boundaries is an almost unconscious act at times, especially in stressful moments (the very same moments when we need them most). This can make it harder to think on your feet when something crosses the line—if you’re like me, you’ll think of the perfect response half an hour later. Think about your boundaries at home where you feel safe. Ask others about their experiences and think about how you would react in a similar situation. Review incidents that have happened in your own past and think about how you could have handled them differently.

I’ve thought back on that meeting with the angry dermatologist and practiced what to say should something like that happen again. I’d calmly express that I was uncomfortable with the behavior and inform the person that I would be leaving. I would also make sure to do this while the nurse was in the room. Lastly, despite the ephemeral nature of his behavior, I would file a complaint.

Communication

Communicating effectively with your health care providers is an important foundation for dealing with situations that potentially cross boundaries. If you and your health care team have built a relationship that is characterized by mutual respect and honesty, it will be easier for you to speak up, and they will be more likely to hear what you’re saying.

Building a good relationship with health professionals starts in the very first appointment. Be polite and professional and use humor if that comes naturally to you. As well, be respectful of their time and what they need to get accomplished in the appointment, but not to the detriment of what you need.

Saying no

Saying no is never easy, especially in a health care setting. Before you set off for your appointment or test, remind yourself that it is OK to say no.

For instance, you may be fine with a student observing your appointment or test, but you have the right to ask that the experienced professional (doctor, X-ray technician, and so on) do the actual exam or test. As well, if a phlebotomist or nurse is having trouble finding a vein, you have the right to ask for someone else.

Having a chronic illness necessitates spending a lot of time in the health care system and you won’t always be able to protect your boundaries. Sometimes, there’s just nothing for it but to go through with a test or procedure that invades all sorts of personal space. But by doing some research and talking to others in the chronic illness community, you can empower yourself to protect your boundaries when feasible and, in the process, having a better experience.

See More Helpful Articles:

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Lene Andersen is the Community Leader for HealthCentral's RA Community. Lene (pronounced Lena) is an award-winning writer, health and disability advocate, and photographer living in Toronto. She’s written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Follow Lene on Twitter @TheSeatedView and on Facebook. Watch her story on HealthCentral.