Respecting boundaries  

Responding to my first dispatch as a newly trained EMT, I arrived at a yard where a man who seemed inebriated was lying. He had slurred speech, and when I asked him a few questions, I realized he had no idea who he was, where he was, or how he got there. My team noticed blood dripping from his shirt. 

The first ordinary social taboo healthcare professionals cross is physical. Fearing the worst, we cut open his shirt to find the source of his bleeding, an open wound on his abdomen. While my partner held pressure to the wound, I touched the patient from head-to-toe in fast, practiced maneuvers. In only one minute, I’ve touched every part of his body. 

The second ordinary social taboo we cross is cognitive. The patient started to push us away, mumbling unintelligibly. He tried to swat our arms away and interfered with our ability to treat his wound. Despite his weak physical protests, we secured him onto a stretcher with soft restraints around his wrists, and by doing so we deemed him incapable of making his own decisions.  

The third ordinary social taboo we cross is emotional. As we prepared for transport, a woman came running, shouting for us to wait. She was his mother. We rushed her into the passenger seat of the ambulance. She told us she’d been looking for her son for hours, and that he may have ingested too much of his father’s pain medication. We started asking her questions about the suspected medication, the general state of her son’s health, and whether this had happened before. She started to cry, disclosing that she had no idea and that she felt like a bad mother. We reassured her that her son is and will be getting the best care possible. We did our best to comfort her while simultaneously working on stabilizing her son.  \

We arrived at the hospital a few minutes later and transferred care to the emergency room staff as quickly and efficiently as possible. In those few minutes, we’d touched the patient’s entire body, took away his autonomy, and reassured his mother about a situation we knew very little about. Deeming it in the best interest of the patient, we crossed all ordinary social taboos guiding physical, cognitive, and emotional boundaries.  

As a second-year medical student, I’ve realized the access given to clinicians only becomes more intimate the deeper into the system that you go. At the same time, patients are not always willing to give that access, understandably so. Their trust in us must be earned, and it’s important to understand the weight of that fact every time access is granted. Though I’m still early in my training, here are a few skills that I aim to grow in and believe every physician should have when interacting with patients. 

1. Invitations and check-ins  

Physical 

Ask whether it’s ok to move forward with the physical exam and wait to start until after they have accepted the invitation.  

Cognitive/emotional 

Ask whether it’s ok to move forward with a difficult conversation. Check in at different times to ask how the patient may be feeling in reaction to serious news. Also, check in for questions.  

2. Clear communication 

Physical 

Explain the purpose of physical exam maneuvers and narrate what physical exam maneuvers you’re doing as you do them. 

Cognitive/emotional 

Summarize what the patient is experiencing, so they understand you’re truly listening. Explicitly express your desire to care for them. 

3. Acknowledging boundaries

Physical 

Verbally acknowledge that a certain physical maneuver may be uncomfortable or even painful. Explain why it’s being performed, and that you’re only doing it because you believe it’s in their best interest. 

Cognitive/emotional 

Verbally acknowledge that a conversation may be difficult or that certain questions may seem invasive. Assure the patient that the information is confidential and only being asked because of how it will inform their care. 

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.