Danger zone. When boundaries are crossed in the doctor-patient relationship.

BACKGROUND: The most obvious boundary violations in medicine are sexual. However, the areas of time management, drug prescribing, accepting gifts, friendships with patients and treating friends also pose ethical dilemmas. Where boundaries lie and how to avoid crossing them can be difficult judgments to make. OBJECTIVE: To examine the issue of boundaries in the doctor-patient relationship and to discuss strategies for avoiding and managing boundary violations. DISCUSSION: The broad concepts of respect for autonomy and avoiding harm to patients and doctors by violating boundaries appears self evident. Where these boundaries lie can appear less clear cut in the detail of individual relationships between doctor and patient. Communicating well with patients about the need for clinical examinations and maintaining objectivity in the doctor-patient relationship is important. Avoiding and managing boundary violations involves awareness of potential hazards, tact and good judgment.