Robin Thicke and Pharrell Williams weren’t talking about the physician–patient relationship when they sing about “blurred lines,” but, personal interaction is the constant that connects that song to our professional experiences. We should never assume we know what is best for someone else or that we should interpret what they say rather than listen.
Few professions allow conversations to move rapidly from introduction to inquiry about an individual’s most intimate, private information. The patient interview involves vulnerability and is relational by nature. As with all relationships, delineation of boundaries and committed respect for the borders are essential to successful, healthy encounters. Performing artists, with singers as a subset, can present unique challenges we should understand.
We can review literature about provider–consumer boundaries and then describe what we consider some of the unique challenges of working with vocalists and other performing artists.
What Is a Physician–Patient Boundary?
This generally refers to the conditions that define and clarify the limits of a fiduciary relationship. This is a relationship in which one person (a patient) entrusts his or her welfare to another (a physician), who receives compensation for delivery of services (JAMA. 1995;274:1345–1346).
What Are the Ethical Foundations that Govern the Need for Boundaries?
Boundaries always exist for protection of all participants. There is a continuum between a boundary crossing and a frank violation. A crossing is a planned or principled deviation from usual, accepted practices. A violation is an unethical and harmful deviation from the standards of care (Am J Psychiatry. 1993;150:188–196).
What’s Different about Performers?
Obviously, performers are generally like any other patient in many ways. However, their personalities and backgrounds have unique implications for their interactions with healthcare providers.
1. Identity intertwined with talent: Some performers equate having a bad performance with being a bad person.
2. Emotional association: A great deal of performing requires emotional intelligence and it is designed to stir the emotions of both the performer and the audience. This creates a degree of vulnerability that can influence factor 1.
3. Lack of awareness: Most artists are not trained to recognize mental health issues or to seek help. They may not see a reason to share symptoms of depression or anxiety with their doctors.
4. Wide exposure to feedback: Artists often receive anonymous, frequently negative, feedback. It can feel like they are offered up for public criticism and consumption.
5. Creativity and psychopathology: There are competing views, but there is a possible predisposition toward addictive behavior and substance abuse (Lancet. 1995;345:138–139; Indian J Psychiatry. 2018;60:168–174; Cogn Neuropsychiatry. 2014;19:359–377). Adverse developmental events in childhood that often foster people pleasing behavior (Prog Brain Res. 2018;237:225–242).
6. Mobility: They may have multiple residences, be traveling on tour, and often documentation of medical history may not be available.