Confronting professional boundaries in medicine 

Physician assistant (PA) school, clinical rotations, and patient interactions are sprinkled with unexpected, life-altering and difficult experiences at every turn.

PAs are trained as generalists, with our curriculum mirroring that of the medical school model. We work collaboratively within the healthcare team, and graduate with the ability to diagnose, prescribe, treat, and monitor patients within any specialty or medical setting.

Yet, one of the most unanticipated challenges I faced during my training was the blurred boundaries between the medical team and myself.

I’m a cancer survivor with a large, albeit well-healed, sometimes visible scar. I’m no stranger to the intense curiosity that motivates strangers to ask ‘what happened to you.’

My natural reaction has been to get defensive and uncomfortable. I credit this to the fact that I was under treatment for osteosarcoma during high school, a time when feelings of insecurity are the norm. These insecurities were further heightened for me as my appearance was uncontrollably altered. I hated that others could look at me, without hair, and automatically get a glance into the struggles I was facing.

More than 10 years later, I’ve become accustomed to curious people asking questions.

However, I was not prepared for this to come from fellow medical providers. In my mind, they should understand the importance of sensitivity around procedures and medical struggles.

Of the hundreds of healthcare providers I interacted with in a given week, many were respectful. But there were a few who asked about my personal health history, often in front of other students, fellows and residents. Some asked in ways similar to how they interact with patients – their concern for my outcome or past struggles apparent. Others did so with casual humor.

Reflecting on the professional relationship that exists between myself and the medical team, the lines between professional and personal are quickly blurred. Perhaps it’s the long hours, stressful situations or the fact that we’re taught as a profession to ask questions and understand our patients’ life stories (including physical and emotional scars). Maybe it’s natural to do the same among our colleagues.

I couldn’t help but think that in many other professions, asking about a trainee or coworkers personal life, despite being ‘in the business’ would be wildly inappropriate. I imagine the boss of my significant other, who works in finance, asking about his financial situation, level of savings or debt and chalking it up to professional curiosity. That would likely never fly.

So, why is it perhaps more accepted in the field of medicine? Professional roles and boundaries are commonly researched and discussed within medicine, but many focus upon the patient-provider role.

Starting as first-year PA students and throughout the curriculum, we’re taught the importance of establishing practices to help ensure boundaries are never blurred with our patients. And while attention is given to diversity, inclusion and equity among medical coworkers, much less training, research, or discussion centers on how to deal with our personal medical issues.

I have learned to take a step back from my experience as a trainee. I appreciate, as a medical provider, the intellectual curiosity for what has happened to another person.

However, I have also felt the frustration that despite trying not be defined by my cancer diagnosis, the physical scars I bear often disqualifies me from keeping my medical journey private.

-By Angelina Romasanta, PA-C, graduate of the Medical Ethics Pathway at Baylor College of Medicine

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