We talked about establishing predictability around handling money here and how respecting your patients’ money and handling it professionally a way of establishing trust. In a way it’s honoring their sacrifice and commitment to their treatment.
We talked about establishing the same predictability and consistency with our time management skillshere for similar reasons. We established it was important to maintain boundaries with our schedule to show respect to all of our patients equally.
We talked about dress codes and breaking taboos here Professionalism is showing up as your authentic self and doing the work. It’s not polos, dress pants and hidden body art.
Personal boundaries are, well, personal
I saved personal boundaries for last because of the four types of professionalism, it’s definitions are the most nebulous. It’s also the one that teaches the hardest lessons and is the most difficult to define for ourselves. Propriety is difficult to define as well, but it’s all about the external influences - what we think society will allow us to do and how willing we are to push against that. Personal boundaries are about our internal influences and what we will allow in our space.
When I was interning in school I had a patient in clinic who loved to ask questions. He had trust issues regarding all healthcare practitioners and he made himself comfortable by getting to know his interns. My supervisor was very familiar with his case and encouraged me to politely answer his questions to develop rapport. Over the course of a few weeks we got to know each other and treatment progressed.
One day, before his treatment he asked to see my supervisor. After a tense and quiet discussion, my supervisor approached me to tell me the patient was no longer comfortable with me treating him. In the process of developing rapport and answering questions we had crossed a boundary - he by asking a question that had a possible answer he would dislike and me by not having a firm enough boundary regarding topics.
This is such a difficult lesson because the boundary is so sudden and it’s different for every patient and practitioner interaction. Sometimes it can even change day to day with the same patient.
Personal boundaries extend to personal space - how and when we allow patients to contact us is a very personal decision and we all do it differently.
Again - it comes back to consistency. Developing boundaries that you can set at the at the beginning of a therapeutic relationship can help prevent these types of things from happening. Consistently enforcing them helps build patient trust.
Here are a few of mine.
I don’t talk about religion with patients - Sometimes, in the course of a massage session or during needling, conversations happen. I tend not to talk because I like to focus, but if a patient chats to relieve tension I always respond. But if a conversation begins to meander into philosophical territories things can get a little hairy. Religion is personal. Their spiritual beliefs mean as much to them as yours do to you.
If there is a difference and it’s amicable, that’s great because dialogue about spiritual difference is awesome - but the treatment table isn’t the place for it. If the difference isn’t amicable you probably just lost a patient and all those possible referrals. Spirituality can be part of your practice - that doesn’t mean it has to be overt.
I don’t talk about politics with patients - With election season coming up, a lot of people have policy on the brain. We’re also all curious about what other people think and who people are voting for. But as with religion, political debate doesn’t belong on the treatment table.
For both religion and politics, I politely explain I don’t discuss religion and politics in the treatment room because I find conversations tend to lead to debate, even if we are in agreement, and energetic conversations tend not to be conducive to a healing environment. No one has ever had an issue with that explanation. It’s not a lie, it’s not hiding anything; it’s just setting a boundary.
The hobbies I discuss with my patients are as boring as white bread - For the patients who like to have conversation, I will occasionally talk about plans for the weekend or evening. But they will be severely censored. I will talk about knitting, music, my cats - pretty much everything the average grandmother would approve of.
I won’t talk about this blog, what I’m reading, what I’ve been cooking, dry needling, dancing, my current meditation practice or any of the woowoo stuff I do in my off time. In and of themselves, these things probably won’t offend anyone. But I know me. And once I get on a tangent about something I love it’s super easy to pull out my soapbox.
I have a google voice number and an email address. I only respond during work hours. This is a relatively new practice and it has changed my life. I shouldn’t be at the beck and call of my work - I have a family and my family needs to come first.
I know we are practitioners and we want to care for our patients at all times, but we are not emergency personnel. If the question our patient has is truly an emergency they should dial 911 or go to the emergency room. If it’s a medical problem they should call their primary care practitioner. Frankly, if it’s in the scope of practice of a massage therapist or an acupuncturist, it can wait until Monday.
Unhappy endings - Yep, we need to go there. This is a huge issue and it probably deserves it’s own blog post but here we go:
It’s a physiological fact - men get erections when sleeping. It’s called “nocturnal penile tumescence”. And they’re not alone, women get clitoral erections too. Apparently it happens 3-5 times a night, or per sleeping period. We can’t control it because 1) we’re asleep and 2) we can’t consciously regulate the levels of norepinephrine or nitric oxide in our blood. So sometimes when men fall asleep on our tables (and probably the women too!) they get an erection.
Do you know what I was taught to do if a man got an erection on my table? I was supposed to step back from the table, call an embarrassing amount of attention to it, and end the session.
Do you know what I do? Nothing. Mainly because they’re sleeping.
My boundary isn’t an uncontrollable physiological response to altered blood chemistry. My boundary is words or touching. Ask for a happy ending? Get out. I didn’t go to school to be a hooker. Don’t come back.
Hint at it? You get shut down verbally because maybe - MAYBE - I’m just in a bad mood and misunderstood you. So I’ll find a way to mention my husband or my education. Mention it again and you’re off the table and out the door. Don’t come back.
I once caught a patient playing with himself, possibly in his sleep. I picked up his hand and moved it. He hasn’t come back. It probably wasn’t in his sleep then. I probably embarrassed him. Good, you're gross. Go be gross somewhere else.
And from the non-sexual side, do NOT hit me to get my attention. Yes, it has happened. Use your words.
In the words of my massage teacher, “You DO NOT touch the therapist!”
Don’t worry if your boundaries drive people away. They should. They will also attract people who respect your boundaries. These are the people who will respect you as a practitioner and a professional, and with that respect comes their trust and their business.
So that’s it. Be consistent when it comes to money. Be consistent when it comes to time. Be consistent with how you portray your brand. And be consistent about what you will and will not share, allow on your table and in your space.
Related links, affiliates links and posts:
4 simple ways to build your patients' trust: pricing
4 simple ways to build your patients' trust: punctuality
4 simple ways to build your patients' trust: propriety
Being Boss 'Redefining Professional'
I Fucking Love Science's "What is a 'Morning Glory'?"
"You are a Badass: How to Stop Doubting Your Greatness and Start Living An Awesome Life" by Jen Sincero
I read this last year and it's time to pull it off the shelf again. Jen Sincero has a kickass attitude about life. This has been one of my favorite inspirational, self-help, get moving in life books. Check it out on Amazon!
I also just started (and am also halfway through) Elizabeth Gilbert's "Big Magic: Creative Living Beyond Fear" and I love it so much. Totally making me rethink my approach to this blog but also how to live creatively in my practice. Future blog post? Quite possibly!
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Your boundaries are going to look different than mine, where do you set them?