Physicians' experiences with patients who transgress boundaries

BACKGROUND: Boundary violations have been discussed in the literature, but most studies report on physician transgressions of boundaries or sexual tra nsgressions by patients. We studied the Incidence of all types of boundary transgressions by patients and physicians' responses to these transgression s, METHODS: We surveyed 1,000 members of the Society of General Internal Medic ine (SGIM) for the number of patient transgressions of boundaries which had occurred in the previous year. Categories were created by the investigator s based on the literature. Physicians picked the most important transgressi on, and then were asked about their response to the transgression and its e ffect on the patient-physician relationship. Attitudinal questions addresse d the likelihood of discharging patients who transgressed boundaries. The i mpact of demographic variables on the incidence of transgressions was analy zed using analysis of variance. RESULTS:Three hundred thirty (37.5%) randomly selected SGIM members respond ed to the survey. Almost three quarters of the respondents had patients who used their first name, while 43% encountered verbal abuse, 39% had patient s who asked personal questions, 31% had patients who were overly affectiona te, and 27% encountered patients who attempted to socialize. All other tran sgressions, including physical abuse and attempts at sexual contact, were u ncommon. Only gender affected the incidence of transgressions; female physi cians encountered more personal questions (P =.001), inappropriate affectio n (P <.005), and sexually explicit language (P <.05) than male physicians a nd responded more negatively to boundary transgressions. Respondents dealt with transgressions by discussion with the patient or colleagues or by igno ring the incident, but such transgressions generally had a negative Impact on the relationship. Meet physicians would discharge patients who engaged i n physical abuse or attempts at sexual contact, but were more tolerant of v erbal abuse and overly affectionate patients. CONCLUSIONS: Boundary transgressions by patients is common, but usually inv olves more minor infractions. Female physicians are more likely to encounte r certain types of transgressions. The incidence and outcomes of such trans gressions are important in assisting physicians to deal effectively with th is issue.