Appropriate Boundaries in the Pediatrician-Family-Patient Relationship (original) (raw)
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Physician Attitudes Toward Personal Relationships With Patients
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Background: Maintenance of appropriate boundaries in the doctorpatient relationship is central to medical professionalism. Little is known about physician attitudes toward personal relationships with patients. Objective: To explore physician attitudes toward a range of personal relationships with patients and the connection between them and other facets of professional behavior. Research Design: National survey by mail using a stratified random sample. Subjects: Active physicians specializing in internal medicine, family medicine, pediatrics, cardiology, surgery, and anesthesiology. Measures: Respondents rated the appropriateness of social, business, and sexual contacts with patients and expressed level of agreement with statements regarding other aspects of medical professionalism relating to patient welfare and professional self-regulation. Endorsement of relationships was dichotomized as never versus rarely, sometimes, often, or always appropriate. Results: A total of 1662 eligible physicians responded of 3504 sampled (adjusted response rate: 58%). Support was high for social relations (91%), somewhat less for business relations (65%), and low for sexual contact (9%). Women, nonwhites, and foreign medical school graduates were less likely to support all 3 relationships. Support for sensitive relationships was associated with rejection of the primacy of patient welfare over physician financial interests (P ϭ 0.015), providing care to indigent patients (P ϭ 0.010), reporting medical errors (P ϭ 0.002), and participating in peer evaluations (P ϭ 0.002). Conclusion: Physicians may perceive different types of relations with patients to fall on a continuum of potential for conflict with their professional role. Support for personal relationships was associated with physician demographic characteristics. More permissive interpersonal boundaries may be associated with weaker support for other professional standards.
Medical Education, 1997
The purpose of this study was to assess the impact of an educational intervention on medical students' attitudes toward social and sexual contact with patients by doctors from three medical specialties (general practice, obstetrics/gynaecology and psychiatry). Medical students from two consecutive ®fth year classes at one medical school participated in one 3 hour session that included instruction on the standards of the profession that prohibit doctor±patient sexual contact. Students were assigned to either intervention groups or control groups and responded to an anonymous questionnaire (overall response rate 66á8%Y n 141. As many as 14á5% of control group students thought it was (sometimes or usually) appropriate for general practitioners to date their own patients and at least 3% thought it appropriate for members of any of these three medical specialties to engage in sexual contact with their own patients. However, there were no sig-ni®cant differences in attitudes toward hugging, dating or sexual contact with current patients between those who had attended the seminar and the control groups. The session signi®cantly in¯uenced attitudes regarding obstetrician/gynaecologists and psychiatrists hugging and having sexual contact with former patients. These ®ndings are discussed in relation to a need for expansion of such instruction.