The Patient/Client Relationship

By Dr. Steven Sims

In an age of rapid technological advances and unprecedented access to information through social media, the relationship between a clinician and a patient remains a unique social system. L. J. Henderson offered an analysis of the skills required to effectively communicate with patients and protect their interests. “Such skill is not only empirical, but it is also, as we vaguely say, intuitive. Sometimes in those favored persons who perceptions and sensibilities are well suited to the task, it results in patterns of behavior that are among the most interesting and, if I may use the word, beautiful that I know.” [Physician and Patient as a Social System, L. J. HENDERSON, M.D.N Engl J Med 1935; 212:819-823 May 2, 1935] When, however, the patient/client has managed to achieve an uncommon social status or influence, it can be difficult for care providers to maintain the patterns that sustain healthy, professional parameters to guide the relationship. The phenomenon by which standard practices become relaxed has been noted and we all need to recognize the common pitfalls and develop potential tools to avoid these mishaps. We are all aware of recent events in which the people taking care of celebrities have been questioned. Many did nothing wrong, but it is often better to protect yourself from the questions. Here are some suggestions:

1. Communicate: Be very clear in what you tell your patient/client. Consider even having them write it down and or repeat it back to you to make sure they heard what you actually said. A paper trail can help bring clarity.

2. Work as part of a team: Along with communicating, it is often a good idea to send information to others so that they can also be aware of what you communicated. Copying managers/assistants on e-mails or texts can be a valuable way to help maintain clarity and promote transparency. We can also hold each other accountable.

3. Be an advocate for your patient/client: this might even mean cancelling a show, but we are charged to do what we think is best for the individual, not the enterprise.

4. Deliver care where it is most appropriate: Sometimes it is okay to treat a patient/client in a dressing room, but think about having an assistant/chaperone to help maintain clarity about what was communicated and what was done. Having the person come to your office/studio—like everyone else does—is also an option.

5. Practice Integrated Healthcare: Be aware of mental health issues including addictive personalities, manipulative personalities, and mood disorders. Consider having your chaperone be a therapist or social worker in some cases.

6. What happens between you two stays between you two: Rarely would you ever need to speak with press about what you’re doing. If you, keep it VERY general and avoid using names. In this age of social media, resist the urge to share everything unless you have permission. Understand that other clients may be taking note of how generous you are about letting everyone who who you’re seeing.

7. Set and honor boundaries: The etymology of the word boundary is to protect that which is sacred. Remember the boundaries help protect your reputation and the practice you’ve worked to build. This is particularly important if you have the ability to prescribe medications. Resist the urge to write a prescription under a pseudonym unless there is a compelling reason.

8. Be culturally aware and competent: Accepting gifts can create problems. However, declining them in a way that appears offensive can also be problematic. Gifts can be accepted and then donated to a third party in a way that reduces harm to everyone. Be aware of norms regarding physical contact as well. Again, a chaperone serves a great function here.

9. Remember you’re a professional, not a fan: It can be rewarding to see someone whose talent you have admired. However, it is critically important to maintain professional objectivity and treat the patient/client, not the superstar.

10. Don’t ask “can I do something?” Ask, SHOULD I do something?”: Just because you have the ability to do something doesn’t mean it is the right thing to do. This internal check can keep you from doing something stupid just because a celebrity asked you to. This is a great way to keep boundaries.