Physicians' experiences with patients who transgress boundaries.

Area of Science:

• Medical Ethics
• Patient-Physician Relationship Dynamics
• Healthcare Professional Well-being

Background:

• Boundary violations in healthcare are under-researched, with a focus on physician or sexual transgressions.
• This study investigates patient-initiated boundary transgressions and physician responses.

Purpose of the Study:

• To determine the incidence of various patient boundary transgressions.
• To analyze physicians' responses to these transgressions.
• To understand the impact of transgressions on the patient-physician relationship.

Main Methods:

• Survey of 1,000 Society of General Internal Medicine (SGIM) members regarding patient boundary transgressions in the prior year.
• Categorization of transgressions based on existing literature.
• Analysis of physician responses, relationship impact, and likelihood of patient discharge.
• Statistical analysis (ANOVA) to assess demographic influences on transgression incidence.

Main Results:

• 37.5% of surveyed physicians responded, reporting common transgressions like use of first names (75%), verbal abuse (43%), personal questions (39%), and socialization attempts (27%).
• Physical abuse and sexual contact attempts were infrequent. Female physicians reported higher rates of personal questions, inappropriate affection, and sexually explicit language.
• Physicians managed transgressions through discussion or by ignoring them, generally resulting in negative relationship impacts. Discharge was more likely for severe transgressions.

Conclusions:

• Patient boundary transgressions are frequent, predominantly minor infractions.
• Female physicians experience specific types of boundary violations more often.
• Understanding transgression incidence and outcomes is vital for effective physician management strategies.