Professional-Patient Boundaries: a National Survey of Primary Care Physicians’ Attitudes and Practices
The essence of humanism in medicine and health care is relationships—caring relationships between clinicians and patients. While raising concerns regarding professional-patient boundaries has positively contributed to our understanding and prevention of potentially harmful boundary violations, there is controversy about which types of relationships, caring acts, and practices are acceptable versus cross boundary lines.
To examine primary care physicians’ practices and attitudes regarding acts that have been questioned as potentially “inappropriate” or “unethical” crossing of professional-patient boundaries.
Surveys conducted via in-person polling or electronic and mailed paper submissions from April 2016 to July 2017. We calculated descriptive statistics and examined associations with practices and attitudes using logistic regression.
Random sample of all US primary care physicians who treat adult patients; convenience sample of attendees at medicine grand rounds presentations.
Outcomes were self-reported practices and attitudes related to giving patients rides home, paying for patients’ medication, helping patients find jobs, employing patients, going to dinner with patients, and providing care to personal friends.
Among 1563 total respondents, 34% had given a ride home, 34% had paid for medications, 15% helped patients find a job, 7% had employed a patient, 10% had dinner with patients, and 59% provided care to personal friends. A majority disapproved of dinner with a patient (75%) but approved of or were neutral on all other scenarios (61–90%).
The medical profession is quite divided on questions related to drawing lines about appropriate boundaries. Contrary to official and widespread proscriptions against such practices (with exception of dinner dates), many have actually engaged in such practices and the majority found them acceptable.
KEY WORDSdoctor-patient relationships professionalism ethics primary care
All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Reyes Nieva and Schiff
Acquisition, analysis, or interpretation of data: All authors
Drafting of the manuscript: Reyes Nieva and Schiff
Critical revision of the manuscript for important intellectual content: All authors
Statistical and geospatial analysis: Reyes Nieva
Administrative, technical, or material support: Reyes Nieva and Ruan
Study supervision: Reyes Nieva and Schiff
This study was funded by the Arnold P. Gold Foundation and the Lucian Leape Family Foundation. The study funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 5.Ama J Ethics. 2015;17(5):416-418. doi: https://doi.org/10.1001/journalofethics.2015.17.5.fred1-1505.CrossRefGoogle Scholar
- 6.Federation of State Medical Boards. Addressing Sexual Boundaries: Guidelines for State Medical Boards. 2006. http://www.fsmb.org/siteassets/advocacy/policies/grpol_sexual-boundaries.pdf. Accessed September 11, 2019.
- 13.Kappers WM, Cutler SL. Poll Everywhere! Even in the Classroom: An Investigation into the Impact of Using PollEverwhere in a Large-Lecture Classroom. Comput Educ J 2015;6(20):140-145.Google Scholar
- 15.Zip Code RUCA Approximation Methodology. http://depts.washington.edu/uwruca/ruca-approx.php. Accessed September 11, 2019.
- 16.The Number of Practicing Primary Care Physicians in the United States. http://www.ahrq.gov/research/findings/factsheets/primary/pcwork1/index.html. Accessed September 11, 2019.
- 17.Rosner B. Fundamentals of Biostatistics. 7 ed: Brooks/Cole: Cengage Learning; 2011.Google Scholar
- 19.Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. The American Association for Public Opinion Research; 2016.Google Scholar
- 20.Diaz-Tena N, Potter F, Sinclair M, Williams S. Logistic Propensity Models to Adjust for Nonresponse in Physician Surveys. 2002; Alexandria, VA.Google Scholar
- 22.Nunnally JC. Psychometric Theory. 2nd ed: New York: McGraw-Hill; 1978.Google Scholar