title: Do patients respect the line? Transgression of boundaries reported by Swiss general practitioners.
abstract: OBJECTIVE
  Transgression of boundaries in the relationship between physician and patient is commonly studied with patient as victim and physician as transgressor. A recent survey in the U.S. reported that almost 90% of physicians face transgression by patients over one year. Incidents happened mainly through verbal abuse, disregarding privacy, and overly affectionate behavior. Since this incidence seems to be alarmingly high, we were interested to analyze how often general practitioners in Switzerland experience transgression by patients.
  
  
  METHODS
  24% of the members of the Swiss Society of Internal Medicine (SGIM) and of the Swiss Society of General Medicine (SGAM) (n=675/2781) responded to an internet-based survey which asked for experiences of transgression by patients and for physicians' responses to transgression in the last 12 months.
  
  
  RESULTS
  81% of responding physicians experienced transgression over the period of one year. Analyzing the frequency of incidents per physician per year, the most common forms of transgression were 'use of physician's first name' (7.7/y), 'asking personal questions' (1.8/y), 'being verbally abusive' (1.5/y), and 'being overly affectionate' (1.4/y). Calculated incidence of transgression was 3 per 1000 patient contacts. 39% of physicians decided to ignore the incident, 37% discussed the event openly. Transgression led to dismissal of patients in 13% of events.
  
  
  CONCLUSIONS
  Transgression even in mild and modest form is a rare phenomenon in Swiss practices.
  
  
  CONCLUSIONS
  The Swiss data do not suggest that there is a specific risk for Swiss practitioners to be exposed to major transgression for which they should specifically be prepared for example in communication skills trainings.
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0804, USA. ahaensel@ucsd.edu
authors.forename: Alexander
authors.initials: A
authors.lastname: Hänsel
authors.forename: Matthias
authors.initials: M
authors.lastname: Nübling
authors.forename: Wolf A
authors.initials: WA
authors.lastname: Langewitz
mesh_terms: D001291:Attitude of Health Personnel; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012919:Social Behavior; D013557:Switzerland