What happened with the Dental Surgeons?

Recently, the College of Dental Surgeons of British Columbia (CDSBC) promoted a new regulation that aimed to ensure professional boundaries were being met for the safety of patients and registrants. The CDSBC created a policy that made it so registrants could not treat a partner or spouse. Registrants of the CDSBC quickly became frustrated with the College, as lots of them had been treating their spouses for quite some time.
Previously the CDSBC bylaws stated that it was sexual misconduct to treat a partner or spouse, but after revision in 2016 the bylaw was changed. Treating your spouse is no longer considered sexual misconduct. Now the bylaws state that it is a matter of professional ethics, which involves patient autonomy, consent and objective care.
So what does the College of Opticians of British Columbia (COBC) have contributed to this discussion? The COBC is currently developing a patient relations program that aims to ensure professional boundaries and support professionalism. We want to start a discussion with our registrants on what guidelines and tools need to be developed to help.
We recognize that situations are not black and white, which is why the COBC wants to provide guidelines to help make professional decisions and ensure public safety.
At COBC we understand there are complex situations that may arise. The goal of our patient-relations program is to equip you with the tools you need to make decisions on your own. We want you to be aware of the issues around conflicts, such as treating your partner or spouse. The COBC wants you to be aware that these decisions may reflect on your professional identity and decision-making.
Let’s take a look at some example situations.
This example outlines the possible lack of objective care when treating your partner or spouse.
Your partner or spouse needs a new set of contacts after significant time away from wearing them. When your spouse comes in to pick up the lenses, it feels condescending and awkward to explain basic instruction about washing their hands or a wearing schedule, so you skip it and assume that your spouse already knows how to treat their contact lenses.
Instructing your patients on proper hygiene, contact lens wear, and lens care practices is an important part of a contact lens fitter’s role, but it may be tempting to skip these instructions with someone you know well. Partners may not tell friends how to complete personal routines or make health choices, but opticians must. When you’re interacting with your partner, you are interacting as equals. As a health care provider, you are expected to act as an expert in your field to ensure that you are passing on the appropriate information for patients to make informed decisions. This power imbalance may feel strange if you are not used to this kind of relationship with someone. It may be strange for you or for them. The patient must be able to trust you as an expert, not as a pal.
The next example will outline the issues of consent and patient autonomy.
Your spouse wants to purchase eyewear but you think they should purchase contact lenses instead. You inform your spouse that you think they should consider contact lenses instead of eyewear.
Your spouse may feel uncomfortable challenging you. This may be because in this moment they are viewing you as a professional that has special knowledge, skills, and abilities. Similarly to the previous example, there is now a power imbalance in your relationship and that power imbalance may feel uncomfortable for either person involved.
Recommended action for both examples:
These examples show that professional and personal relationships are different and having both at once may create issues with care—often issues that you would not immediately notice. It is important to stay vigilant in the way that professional boundaries help you do your job better and support patient comfort. Consider directing your spouse to a fellow contact lens fitter that you can trust for assistance if you do not feel that you can treat them like any other patient.
At first glance is may seem harmless, however, it is important to consider the issues that may arise when treating your spouse or partner. The COBC encourages you to use these tools and the information provided to make your own informed choices.
If you have any questions regarding this toolkit or patient-relations do not hesitate to contact us at 604-278-7510 or reception@cobc.ca