Chiropractic is a very “hands on” profession. As such, chiropractors are at higher risk for allegations of sexual misconduct by their patients. Therefore, it is of utmost importance that chiropractors appropriately educate their patients regarding chiropractic treatment and maintain healthy boundaries with their patients. 

Patients can be in a vulnerable position. They may be in pain, placed in a closed room with only the chiropractor present, and physically touched by the chiropractor as part of their treatment. Clear communication with patients helps to put patients at ease and avoid misunderstandings. 

Understanding Boundaries & Breaches
A boundary is the line separating a professional, therapeutic relationship between the doctor and patient with relationships that are casual, personal, and familial. A functional boundary enables the doctor to treat a patient to achieve an optimal outcome, but boundary violations can cause serious harm to the patient.

A breach of sexual boundaries occurs when a chiropractor displays sexualized behavior towards a patient or parent/guardian. Breaches of sexual boundaries do not just include criminal acts such as rape or sexual assault, but cover a spectrum of behaviors including: 

• Asking for or accepting a date
• Sexual humor during consultations or examinations
• Inappropriate sexual or demeaning comments, or asking clinically irrelevant questions, for example about their body, underwear, or sexual performance
• Routine or non-therapeutic hugging of patients
• Requesting details of sexual orientation, sexual history, or sexual preferences that are not necessary or relevant
• Asking for, or accepting an offer of, sex
• Watching a patient undress
• Unnecessary exposure of the patient’s body
• Accessing a patient’s or family member’s records to find out personal information not clinically required for their treatment
• Taking or keeping photographs of the patient or their family that are not clinically necessary
• Telling patients about their own sexual problems, preferences, or fantasies, or disclosing other intimate personal details

Risk Reduction Techniques

1. Avoid clinical or non-clinical contact or behavior that a patient may perceive as a romantic or sexual overture.
2. Follow professional ethical guidelines regarding intimate relationships with former, present, and future patients.
3. During examination and treatment, educate patients about what to expect and the necessity of procedural touch and utilize only the amount of physical contact necessary for diagnosis and treatment.
4. Give clear instructions about which articles of clothing the patient should remove, and which should remain on and provide the patient with a gown, sheet and/or other appropriate covering if appropriate for patient modesty.
5. Give the patient a reasonable time to disrobe and drape, then knock on the examination room door to announce your reentry into the room and wait for a response.
6. Institute a chaperone policy in your practice and communicate your policy to patients. A chaperone should be present in the examination/treatment room if the patient is asked to disrobe or if a patient requests a chaperone. Document the presence of a chaperone in the patient’s record, or the patient’s refusal of a chaperone if one is offered and the patient refuses.

Being aware of your actions, words, and behaviors and how those may be perceived by your patient is extremely important in these situations. Chiropractors should remain professional and avoid any contact or conversations that could be interpreted as sexual in any way.

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“OUM” and “OUM Chiropractor Program” do not refer to a legal entity or insurance company but to a program or symbol of a program underwritten, insured, and administered by ProAssurance. The information contained on the OUM Chiropractor Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.