Boundary Crossing or Violations: What to do if you are concerned you are at risk

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Boundary Crossing or Violations: What to do if you are concerned you are at risk

• Document any inappropriate behavior on the part of the patient.

• Focus objectively on the patient’s needs and best interests.

• Establish and maintain appropriate boundaries; look at the relationship from three perspectives - physician’s, the patient’s, and the neutral observer’s. - The physician’s: Be clear about your own needs and experiences in the relationship. - The patient’s: Try to understand how the patient is experiencing your behavior. Empathize with what she or he is experiencing. - The neutral observer’s: Step outside the relationship. Try to understand what an outsider would see when observing your relationship. Strive for objectivity and fair solutions to problems in the patient’s best interests.

• Treat all patients equally - function compassionately and free of preferences for some patients.

• Encourage patients to take responsibility for their own health. Don’t impose your knowledge and authority.

• Do not accept inappropriate gifts from patients. Patients who offer gifts of great value should receive a sensitive explanation as to why the gift cannot be accepted. The frequency of gifts given by the patient, regardless of their value, should also be considered.

• Do not imply that patients are obligated in some way. Do not expect patients to return kindnesses or to be thankful.

• Ask yourself why you are acting in a particular way, i.e., stress, burnout, failed relationship, depression, etc.

• Discuss the situation with a colleague (of course, adhering to patient confidentiality) and document the discussion in the patient’s chart.*

If you have concerns and wish confidential advice, call MPHP. If appropriate, you can be referred, if you wish, to another professional.

Many CME courses are available on boundary issues. Two options are courses through or Vanderbilt University at

If you would like more resource material, MPHP can suggest materials for further reading. Contact the editor for information.


* Information prepared by the Hawaii Physicians Health Program, Pu’ulu Lapa’au.