By Stacey Kusterbeck
“Can I have your cell phone number, just in case I have any questions?”
Banu Symington, MD, MACP, is routinely put on the spot with this request, by both patients and colleagues. Symington very often takes calls during off-hours.
“I am a solo practitioner, and I am never off. And then we talk about why providers don’t want to locate in rural locations, where they are the only ones,” says Symington, an oncologist and medical director at Sweetwater Regional Cancer Center in Rock Springs, WY.
Years ago, one medical director Symington worked with went so far as to state that willingness to share personal cell phone numbers with patients would factor into physicians’ annual bonuses. “The expectation was that clinicians be available all the time,” says Symington.
In Symington’s experience, it is a small minority of patients who inconsiderately encroach on a physician’s time off. One patient recently called at 3 a.m. to ask for medication for insomnia. “She woke me to ask for something I could not give her, since we have no overnight pharmacies,” says Symington.
Polo Camacho, PhD, co-authored a recent paper exploring ethical issues that arise in the context of patient-clinician communication.1 “Promoting clinician well-being is critical to the provision of cancer care and for cultivating a healthy oncology workforce,” says Camacho, ethics program manager and bioethicist at the American Society of Clinical Oncology.
Some physicians are torn between promoting their own well-being by establishing healthy communication boundaries and meeting the expectations of their institutions. Given the estimated shortfall of oncologists in the coming years, and evidence that failing to support clinician well-being can lead to alcohol misuse, depression, and burnout, Camacho and colleagues sought to provide recommendations to help oncologists to navigate thorny communication issues. “We offer several recommendations that may be of interest to bioethicists working in healthcare settings,” says Camacho.
Bioethicists can help develop policies on maintaining healthy communication boundaries. For instance, institutions can inform patients who to call during emergent vs. non-emergent scenarios or business vs. non-business hours. Ethicists also can encourage clinicians to identify boundaries by answering questions such as “How much time do I need for myself to rest and recharge?” and “Do I have time for myself, my family, my hobbies, and my wellness?”
“Clinical ethicists may explore these recommendations during hospital ethics committee meetings and clinical ethics consultations,” offers Camacho.
- Chatwal MS, Camacho P, Symington B, et al. Ethics of patient-clinician boundaries in oncology: Communication strategies for promoting clinician well-being and quality patient care. JCO Oncol Pract 2024;20:1016-1020.
