Patient-physician boundaries in palliative care training: a case study and discussion.
Abstract The subject of patient-physician boundaries has been most extensively explored in the psychiatric literature, but to date, little has been published about this concept within the realm of palliative care. Some palliative care physicians may be particularly susceptible to boundary crossings due to the intensity and intimacy of the bonds that form with patients at the end-of-life. We illustrate the concept of boundary crossings and violations in palliative care using the case of a palliative care trainee who experiences difficulties in maintaining boundaries with a dying patient. We discuss the nature of the patient-physician relationship using role theory and discuss how the formation of dual roles can be detrimental to the patient-physician relationship. Finally, we explore why palliative care practitioners and trainees are particularly vulnerable to crossing boundaries and how to recognize and manage these crossings when they occur.
Nasrallah
Sandra M
SM
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. snasrallah@partners.org
Maytal
Guy
G
Skarf
Lara M
LM
D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000473:pathology / Q000523:psychology; D001007:Anxiety; D001293:Attitude to Death; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care / Q000941:ethics* / Q000379:methods / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics*; D024382:Professional Role / Q000523:psychology*; D013727:Terminal Care / Q000941:ethics* / Q000523:psychology / Q000592:standards