Observing Professional Boundaries

A physician’s personal interest in his or her patients has a recognized therapeutic effect on those patients’ sense of well-being and return to health. At the same time, physicians’ actions in patients’ behalf must comply with professional boundary guidelines. How far may a doctor go to assist a patient with nonclinical matters—joblessness, lack of transportation, fear of doctors’ offices—that impede the patient’s medical treatment? Contributors to the May issue of the AMA Journal of Ethics help distinguish boundary crossings—benevolent acts outside the scope of clinical interventions—from boundary violations—breaches of practice that may place patients’ bodily or psychological well-being at risk.

Volume 17, Number 5: 407-487 Full Issue PDF
  • From the Editor
    May 2015

    Professional Boundaries and Meaningful Care

    Nadi N. Kaonga, MHS
    Does helping a patient overcome systemic barriers to health by satisfying basic needs for food, clothing, shelter, and employment violate professional boundaries?
    AMA J Ethics. 2015;17(5):416-418. doi: 10.1001/journalofethics.2015.17.5.fred1-1505.
  • Case and Commentary
    May 2015

    Balancing Practice Policies with Patient Needs

    Eric Goepfert, MD and Brian Kroener
    A clinical practice policy prohibiting house calls that opposes the practice standards of individual clinicians may be unethical and reasonable, but it may still be possible to treat patients who prefer house calls while abiding by the policy.
    AMA J Ethics. 2015;17(5):419-424. doi: 10.1001/journalofethics.2015.17.5.ecas1-1505.
  • Case and Commentary
    May 2015

    Does Helping a Patient Find a Job Violate Professional Boundaries?

    John M. Mazzullo, MD
    Networking with a friend to help a patient gain employment is not unethical as long as confidentiality is maintained and the patient grants his or her doctor permission to discuss the situation with the friend.
    AMA J Ethics. 2015;17(5):425-427. doi: 10.1001/journalofethics.2015.17.5.ecas2-1505.
  • Case and Commentary
    May 2015

    A Friend’s Request for Treatment

    Horacio Hojman, MD
    Although the practice guidelines of several medical organizations recommend against treating friends or relatives, they make exceptions for emergencies or the unavailability of other qualified physicians.
    AMA J Ethics. 2015;17(5):428-431. doi: 10.1001/journalofethics.2015.17.5.ecas3-1505.
  • In the Literature
    May 2015

    Professional Guidelines for Social Media Use: A Starting Point

    Terry Kind, MD, MPH
    The American College of Physicians and the Federation of State Medical Boards’ guidelines for online medical professionalism apply existing norms of communication and confidentiality to new settings but will need to be modified in light of technological advances and unanswered questions.
    AMA J Ethics. 2015;17(5):441-447. doi: 10.1001/journalofethics.2015.17.5.nlit1-1505.
  • AMA Code Says
    May 2015

    AMA Code of Medical Ethics’ Opinions on Observing Professional Boundaries and Meeting Professional Responsibilities

    AMA Council on Ethical and Judicial Affairs
    The American Medical Association Code of Medical Ethics’ opinions on professionalism and the use of social media, sexual misconduct in the practice of medicine, sexual or romantic relations between physicians and key third parties, and physicians’ duty to care for the poor.
    AMA J Ethics. 2015;17(5):432-434. doi: 10.1001/journalofethics.2015.17.5.coet1-1505.
  • Policy Forum
    May 2015

    The Need for Professional Standards in Global Health

    Roy Ahn, MPH, ScD, Kristina Tester, Zaid Altawil, MD, and Thomas F. Burke, MD
    To promote good practices, non-governmental organizations (NGOs) working in global health should adopt and follow rules of professional conduct that put communities’ wants and needs over those of the NGOs.
    AMA J Ethics. 2015;17(5):456-460. doi: 10.1001/journalofethics.2015.17.5.pfor2-1505.
  • Medicine and Society
    May 2015

    Necessary Boundary Crossings in Pediatrics

    Emily Thompson
    To help a seriously ill young patient whose normal childhood has been disrupted, pediatricians must be more than sympathetic professionals in white coats—they must know how to motivate each patient and then go the extra mile to do so.
    AMA J Ethics. 2015;17(5):461-464. doi: 10.1001/journalofethics.2015.17.5.msoc1-1505.
  • Personal Narrative
    May 2015

    Doctoring for the Homeless: Caring for the Most Vulnerable by Building Trust

    Monica Bharel, MD, MPH
    The Boston Health Care for the Homeless Program (BHCHP) seeks to build trusting relationships with patients before addressing their medical needs and to take account of their surrounding environment in treatment.
    AMA J Ethics. 2015;17(5):469-472. doi: 10.1001/journalofethics.2015.17.5.mnar2-1505.
  • Personal Narrative
    May 2015

    The Changing Patient-Physician Relationship

    James M. Thompson, MD
    Since the late 1970s, radical changes have occurred in the patient-physician relationship and in practice management and administration, and the future holds promise of more evidence-supported treatments.
    AMA J Ethics. 2015;17(5):473-476. doi: 10.1001/journalofethics.2015.17.5.mnar3-1505.
  • Viewpoint
    May 2015

    Incorporating Spirituality into Patient Care

    Robert D. Orr, MD, CM
    Physicians must recognize the role of their own and patients’ religious and personal values in understanding and resolving dilemmas in clinical ethics.
    AMA J Ethics. 2015;17(5):409-415. doi: 10.1001/journalofethics.2015.17.5.spec1-1505.