Physician attitudes toward personal relationships with patients

Maintenance of appropriate boundaries in the doctor-patient relationship is central to medical professionalism. Little is known about physician attitudes toward personal relationships with patients.

To explore physician attitudes toward a range of personal relationships with patients and the connection between them and other facets of professional behavior.

National survey by mail using a stratified random sample.

Active physicians specializing in internal medicine, family medicine, pediatrics, cardiology, surgery, and anesthesiology.

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.

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 = 0.015), providing care to indigent patients (P = 0.010), reporting medical errors (P = 0.002), and participating in peer evaluations (P = 0.002).

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.