Doctors' perceptions of personal boundaries to primary care interactions: a qualitative investigation

Definitions of professional roles and appropriate care are increasingly inclusive in primary care but many subjective factors influence the care that is actually delivered. One such factor is the boundary a clinician puts on his or her self in interactions with patients. This qualitative study investigated doctors' perceptions of personal boundaries to primary care consultations by exploring two examples: touch and spiritual care. Respondents reported clear but contrasting boundaries: some neither used touch nor explored spiritual care; others regularly undertook both. Some interviewees deliberately varied these boundaries, irrespective of their own views, if they felt this was in their patients' best interests. Such subjective limits may affect the quality of primary health care offered to some patients and contrast with theoretical definitions which assume both all-encompassing primary care, and doctors' conscious awareness of themselves and their personal boundaries. The existence of these boundaries, and some doctors' lack of awareness of them, has educational implications if patient-centred professional role definitions are to be realistically delivered in everyday primary care.