Confessions of a GP

Boundaries

Mark is about my age and I can’t help but like the bloke. He is friendly, funny and interesting and if he wasn’t one of my patients, I imagine he could well be one of my friends. He has bipolar disorder, which means that he can get very depressed at times and at others can become as high as a kite and dangerously manic. It is a tough condition to live with and I like to see him every few weeks to make sure everything is stable.

After a few months I’ve got to know him quite well. I know about his job and his family and his relationships. He can see the funny side of his illness and he makes me laugh with some of the stories he tells. Each time he comes to see me he asks how I am. Lots of my patients ask me this but most don’t actually want me to answer. People visit the doctor to gratefully offload in one direction only. I don’t have a problem with that, but Mark is different. We get on well and I genuinely feel that he does care how I am. It feels odd him calling me Dr Daniels rather than using my first name and I think that he would like me to take down my professional barrier and have our consultations as more like chats between two friends.

It is very tempting to give in and do just that. My days at work can be long and lonely. I am constantly speaking and interacting with people, but at the same time I’m not really allowed to be my real self or relax. I would love to have a proper chat with Mark and tell him a funny story about my weekend or let him know what really pissed me off about something that happened that morning, but I don’t. I keep the barrier up for the protection of both of us. Mark is not my friend, he is my patient. If he viewed me as a friend, he might feel uneasy disclosing something to me. He might worry about what I thought or care about my opinion of him. At some time in the future he might become really unwell and need advice he doesn’t want to hear, or worse still one day he might need sectioning. How could I act objectively as his doctor if I regarded him as a friend? It might come across as a bit stuffy calling myself Dr Daniels and refusing to talk about myself to patients, but boundaries are important. Mark has other friends but I’m his only GP. The doctor–patient relationship is unique and worth maintaining.