By Cheong Pak Yean
On the subject of propriety and sexual boundaries, the 2016 Singapore Medical Council Handbook, section C4, has this to say:
…….maintain propriety and take care not to breach sexual boundaries when managing patients, through inappropriate physical contact, or any sexualised behavior of any kind…….not only about avoiding inappropriate physical or genital contact…. Sexual boundary breaches can occur with both male and female doctors and with male or female patients.
Doctor, Please Hug Me!
Dr Roger Than* noticed that Jane* had attended many times during the past year for various symptoms like giddiness and chest pain. Her present problem was a panic attack. Dr Than decided to ask more this visit.
Jane revealed that she had been estranged from her husband for one year. She and her husband lived together but led separate lives. They communicated via Post-It notes or cellphone texts even if they were both home. Her husband slept in the study. Jane denied depression or suicidal thoughts. Dr Than reminded her that he was always there for her, and that she should come to the clinic at any time if she ever thought of attempting suicide. Before Jane left the consultation room, she surprised Dr Tan by saying, “Please hug me.”
The doctor was in a quandary. To hug her risked breaching sexual boundaries. Did Jane feel that he was a surrogate? Not to hug her, or to expressly ask the female chaperone to return to witness the hug, would smack of insincerity. A discourse on ethics and boundaries would fall flat.
After a moment of awkward silence, Dr Than said, “Jane, may I ask why you made that request?” Jane answered, “For the longest time, I have felt dead. I am unworthy of human contact. What you just said touched me.” “ And what would you feel if I hug you?”, to which Jane replied, “I would feel alive; a human being again.” At this the doctor placed his hand on her shoulder and warmly shook her hand with the other.
*Names have been changed.
Commentary
Violations of sexual boundaries are serious offenses even if the relationship with the patient is consensual.
The drawing depicts a surreal scene. The male doctor in the foreground has fixated his gaze on the demure, innocent-looking girl. We see flies busily buzzing around. A mysterious figure in black, with three hands, hovers in the background. One hand is preventing physical contact with the young girl, another hand is grasping a slimy green object from which the flies appear to emerge, and a third hand is around two mature women with exaggerated lips, as if readying them for the next encounter. Is the black figure a symbol of provocation and restraint that some practitioners struggle with?
Human presence and relatedness are part of healing. The vignette reminds us that there are times the physician heals only when he is humanly present to another human in distress. Jane is asking for existential affirmation of her being human — a request that is neither sexual or romantic. A powerful therapeutic opportunity would be lost if the doctor’s response is insensitive.
Doctors need to be able to identify and navigate perceived intrusion of boundaries, and have supervisors that they can share these situations with, in order to practice safely, ethically, and therapeutically.
———A/Prof Cheong Pak Yean
Cheong Pak Yean is an internal/family physician and psychotherapist. He is an SMA honarary member, past president SMA, College, and adjunct associate professor of NUS. His current interest is in medical communication and humanities.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
