Focus: establishing boundaries with family members who request favours
An occupational therapist practising on an acute care psychiatric unit receives a phone message from her cousin who is a health care professional working in community mental health. The cousin had just visited his close friend who is a client on the unit and working with the occupational therapist. The cousin is seeking information about his friend’s care and would like to support him post discharge. The occupational therapist has just completed an assessment during which time the client expressed he had limited supports in the community.
How should the occupational therapist respond? (Select 2)
- Inform the cousin that the information is accessible to him via the client’s e-record.
- Offer to send the cousin a copy of the client’s assessment, in confidence, provided he does not share it.
- Inform the cousin that this information is confidential and cannot be shared without the client’s permission.
- Do not respond to the call and avoid the cousin until the client has been discharged.
- Invite the cousin to attend the unit’s rounds to discuss discharge plans for the client.
- Suggest the cousin contact the client directly to offer his support post-discharge.
College Preferred Answers
3 and 6 are correct
This case is related to both the Conflict of Interest (COI) and the Managing Client Information (MCI) practice standards and illustrates how a conflict of interest can be interconnected with other practice issues such as patient/client privacy.
COI Practice Standard #2: Preventing Conflict of Interest (2016) states that “occupational therapists must maintain a relationship of trust and confidence by not taking advantage of his or her position, including access to privileged information or knowledge received in dealings with clients or organizations” (p. 17). As an occupational therapist on the unit, the occupational therapist has access to privileged confidential information. The occupational therapist must not use this information for her benefit or for the benefit of her family, in this case, her cousin.
Additionally, MCI Practice Standard #4: Disclosing the Occupational Therapy Record (2014), states “the occupational therapist will transfer, share, or disclose personal information only with the express consent of the client unless otherwise permitted to do so by law” (p. 2).
By suggesting that the cousin talk with the client and offer his support, the client is directly informed of the support available and is able to control if and/or how he accepts it. If interested, the client may choose to invite his friend to become more actively involved in discharge planning.
1 is incorrect
The cousin is not seeking information from the occupational therapist in the capacity of a health care professional. By recommending the cousin access the e-record, the occupational therapist is encouraging a breach of the client’s privacy in an attempt to meet the interests of a family member.
2 is incorrect
The client has not provided consent to disclose this information, even ‘in confidence’.
4 is incorrect
Occupational therapists have the responsibility to manage professional boundaries and communicate honestly and transparently. By ignoring the cousin’s message, the occupational therapist is not meeting these expectations. Additionally, the COTBC Code of Ethics states that occupational therapists “assist their colleagues to recognize and address potential boundary violations” (p. 9). Given the cousin is also a health care professional, by ignoring this request the occupational therapist is not fulfilling this responsibility. An additional consideration is that if the occupational therapist ignores the message, the client may not be able to benefit from a potentially valuable support upon discharge. This is not acting in the client’s best interest.
5 is incorrect
Consistent with answers 1 and 2, the client has not provided consent to disclose his personal information. Additionally, the occupational therapist’s cousin is not the client’s health care professional.
Additional Questions for Reflection
Additional questions for reflection, on your own or with others…
- What would you do in a similar situation?
- What other factors might have made it easier or more difficult for the occupational therapist to maintain professional boundaries?
- What organizational policies are in place – or could be – to help prevent conflicts of interest in your practice?
College of Occupational Therapists of British Columbia. (2014). Code of ethics, pp. 8-9.
College of Occupational Therapists of British Columbia. (2014). Managing client information practice standard #4: Disclosing the occupational therapy record, p. 2.
College of Occupational Therapists of British Columbia. (2016). Conflict of interest practice standard #2: Preventing Conflict of Interest, p. 17.