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Boundaries issues: In the 5.5 years I spent in the community of my residency program, I only once ran into a patient outside of hospital or clinic. Now, in a much larger metro area, it seems that 2 or 3 times a year it is happening to me, and now this month it has happened to me twice, and more specifically, in my own church.
I think it may be that the church I attend, though not large, is very active in outreach to its corner of the metro area, making it attractive and welcoming to folks like the mentally ill and marginalized. Also by chance, my outpatient clinic is located less than a mile from the church--so, all in all, my patient base is somewhat skewed toward our quadrant of the metro. In addition, one of our leaders is on the staff of a major shelter for homeless women & families--which seems to have a fairly substantial overlap with our clientele at the hospital and clinic. Still, I don't advertise myself, and I certainly don't seek patients among my co-parishioners!
So last Sunday I look up, and there in the next row is this nice chronic schizophrenic lady that I see about twice a year in clinic. She recognizes me and asks me, "Am I seeing you tomorrow?" Well, I have no idea, and politely tell her so, bid her good day in a superficially social way, and that's that. Next day in clinic, sure enough, she had an appointment. She tells me that she used to know the pastors in their previous church, and wanted to get back to going to church. I gave her my usual spiel that I wouldn't divulge that she was my patient unless she specifically gave me permission, and that she shouldn't try to transact "doctor business" at church, etc. She agrees, understands, etc...no problem. So tonight I'm in a church small group in a friend's home--and guess who's there...
I certainly don't want her to feel bad about appropriately pursuing relationships in the church of her choice, but neither do I want to change my style, or have to stop being a part of activities that bring balance and sanity to my life. Nevertheless, it feels somewhat uncomfortable in the more intimate setting, where more personal information gets shared, where my family's present, etc. Again, she's a nice enough person, and only an occasional med refill patient, but this seems to happen to me regularly. What if it were a more antisocial bipolar? Or a really intense borderline? I know several of them who live within a mile's radius of the church as well...
So anyhow--just thought I'd toss it out there to let you all kick the question around a bit. Am I making too big a deal of it? Too little? I grew up in a small town where the FPs all were a part of the town's social fabric--church, school, grocery store, golf course, etc. How different is that?
I think it may be that the church I attend, though not large, is very active in outreach to its corner of the metro area, making it attractive and welcoming to folks like the mentally ill and marginalized. Also by chance, my outpatient clinic is located less than a mile from the church--so, all in all, my patient base is somewhat skewed toward our quadrant of the metro. In addition, one of our leaders is on the staff of a major shelter for homeless women & families--which seems to have a fairly substantial overlap with our clientele at the hospital and clinic. Still, I don't advertise myself, and I certainly don't seek patients among my co-parishioners!
So last Sunday I look up, and there in the next row is this nice chronic schizophrenic lady that I see about twice a year in clinic. She recognizes me and asks me, "Am I seeing you tomorrow?" Well, I have no idea, and politely tell her so, bid her good day in a superficially social way, and that's that. Next day in clinic, sure enough, she had an appointment. She tells me that she used to know the pastors in their previous church, and wanted to get back to going to church. I gave her my usual spiel that I wouldn't divulge that she was my patient unless she specifically gave me permission, and that she shouldn't try to transact "doctor business" at church, etc. She agrees, understands, etc...no problem. So tonight I'm in a church small group in a friend's home--and guess who's there...
I certainly don't want her to feel bad about appropriately pursuing relationships in the church of her choice, but neither do I want to change my style, or have to stop being a part of activities that bring balance and sanity to my life. Nevertheless, it feels somewhat uncomfortable in the more intimate setting, where more personal information gets shared, where my family's present, etc. Again, she's a nice enough person, and only an occasional med refill patient, but this seems to happen to me regularly. What if it were a more antisocial bipolar? Or a really intense borderline? I know several of them who live within a mile's radius of the church as well...
So anyhow--just thought I'd toss it out there to let you all kick the question around a bit. Am I making too big a deal of it? Too little? I grew up in a small town where the FPs all were a part of the town's social fabric--church, school, grocery store, golf course, etc. How different is that?