The Ethical Risks of Professional Boundaries

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The Ethical Risks of Professional Boundaries

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The Ethical Risks of Professional Boundaries

The Ethical Risks of Professional Boundaries is a unique approach to boundary setting for professionals in healthcare. All professionals cross boundaries. Most of these crossings are benign and probably helpful to the relationship and therefore helpful for the care of the patient, but if they lead to a violation of boundaries, a toxic environment may arise.

A licensed professional simply can’t understand how to set their own boundaries with patients and clients if they do not understand themselves, what they are vulnerable to, and why. They must recognize that they are the product of their training, family upbringing, reaction patterns to stress, and emotional intelligence and empathy levels. This handbook addresses self-evaluation to determine if the healthcare professional is a high risk for violating boundaries. This guide enables each professional to understand his or her best methods to setting proper boundaries. The goal of the book is to educate, inform, and illustrate how each professional can set their own boundaries to avoid unnecessary trauma and conflict.

This book will help the reader:

  • Develop an outline for identifying problematic thinking patterns
  • Create long-term strategies for self-assessment, balance, and how to interact with your fiduciary regulatory body or board
  • Formulate treatment plans to keep you within your boundaries and how to detect possible problems before they arise
  • Develop checklists reflecting personal inventories as tools for self-assessment


Published: February 2021

Page count: 130
Dimensions: 7” X 9” perfect bound
ISBN: 978-1-64535-100-9

Table of Contents

Chapter 1: Boundary Crossings and Violations

History and Research of Violations
No Provider Is Immune
A Whole Lot of Gray
Takeaways

Chapter 2: The Importance of The Provider’s Family Systems in the Formation of Appropriate Boundaries

Creating Self-Awareness
Predispositions to Dysfunction
Genesis of Boundary Violations
Family Systems: Rules and Roles
Attachment Templates and Theories
Takeaways 

Chapter 3: The Road to Boundary Violations

Success, Power, and Distance
The Consequences of Medical Training and Career Development
Elements of the Provider-Patient Relationship
Other Factors Contributing to the Power Differential
Provider Vulnerability
Takeaways 

Chapter 4: The Influence of Empathy

The Importance and Benefits of Empathy
Acceptance and Evolution of Empathy in Healthcare
Empathy Defined
The Neuroscience of Empathy
Active Listening and Empathy
Achieving the Correct Balance
The Endgame of Empathy
Takeaways 

Chapter 5: The Ethics of It All

How Ethics Applies to Medicine
Ethics and Romance
Takeaways 

Chapter 6: Healthy Sexual Boundaries

The Sexual Journey
Is Sex the End of the Sexual Journey?
Nonverbal Parts of Sexuality
Takeaways 

Chapter 7: Separating the Problems from the Issues with Sexual Boundary Violations

When Does Behavior Become Problematic?
Boundary Crossings and Boundary Transgressions
Healthy Boundaries Help Define Healthy Sexuality and Behavior
The ‘Problem Patient’ Is Not the Issue
Redirecting Confusing Messages
What Happens When Boundaries Are Broken by Problematic Behavior?
Assessment and Treatment
Patients’ Rights—A Final Word 

Chapter 8: Electronic Media: Positives and Negatives

Social Media as a Tool
Pause Before You Post
Takeaways 

Chapter 9: Long-Term Strategies

Keeping Stress and Burnout at Bay
Professional Strategies to Keep Boundaries in Check
Takeaways 

Chapter 10: Potholes and Pearls

About the Author

R. Dean White, DDS, MS

R. Dean White, DDS, MS, has been involved in medical staff governance his entire career. He has served on virtually every medical staff committee and served as the chief of the medical staff in 1999 and 2000 at Texas Health Harris Methodist HEB Hospital in Bedford, Texas. He served on the board of trustees for the same hospital for six years. He served as the part-time medical staff advisor from 2002–2011 and was responsible for medical staff orientation, leadership development, coaching and mentoring, behavioral event peer review, and the physician health committee. He championed and helped implement the medical staff code of conduct in 2003.

Dr. White frequently presents and consults with medical staffs and their leadership as well as medical staff professionals on a state and national level. For 10 years, he served on the faculty for Maintaining Proper Boundaries, cosponsored by Santé Center for Healing and Southwestern Medical School. He has been a speaker for the Greeley Medical Staff Institute and the National Association of Medical Staff Services and the American College of Healthcare Executives on several occasions. His topics include managing disruptive behavior and impairment, burnout and balance, the aging physician, leadership principles for physicians, medical staff boundaries, prescribing practices, ethics in a changed workplace, and empathy training for the physician. He is the coauthor of A Practical Guide to Managing Disruptive and Impaired Physicians (©HCPro 2010), Medical Staff Leadership Essentials: A Guide to Developing Leadership Skills and Recruiting the Next Generation (©HCPro 2011), and What the Hell Do I Do Now? A Professionals’ Guide to a Meaningful Retirement (©Book Locker 2012). He received his dental degree and oral and maxillofacial surgery training and Master of Science degree from the University of Texas Dental Branch in Houston.


James C. “Jes” Montgomery, MD

James C. “Jes” Montgomery, MD, began his career in medicine as a family physician in 1983 after graduating from LSU School of Medicine in New Orleans in December 1979. He received his certification in treating addictions in 1987. He worked in addiction medicine until 1992, when he entered a psychiatry residency at LSU Medical Center in New Orleans.

In 1996, he became the founding medical director at Santé Center for Healing in Argyle, Texas, a residential addiction treatment center with a focus on healthcare professionals with addictive disorders and sexual boundary violations. From 1995–1997, he worked with the Ross Institute for Trauma Treatment at Timberlawn Hospital and, in 1997, became the medical director at the Pride Unit, a program of addiction treatment for the LGBTQ population at Millwood Hospital. In 2003, he returned to Santé Center for Healing and transitioned into medical director, also participating in the “Maintaining Proper Boundaries Course” under the guidance of Vanderbilt University and University of Texas Southwestern until 2011. He then assumed the psychiatric directorship of the Gentle Path Sexual Addiction Program at Pine Grove Behavioral Health and Addictions in Hattiesburg, Mississippi, until 2016, continuing as a consultant until 2018. In 2016, he joined the staff at Serenity View Treatment Center as the Program Director for the Professionals Program for HCP's and other professionals, including Professional Athletes until 2019.  Since then, his focus has been on private practice and the development of effective insights from technological monitoring of persons with Substance Use Disorders through ViviHealth.