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Physical contact in the physician-patient relationship

For several decades now, medical regulatory authorities have been discussing and writing about the importance of maintaining professional boundaries in the physician-patient relationship. Boundaries are required rules or limits that recognize the inherent power imbalance present in such relationships, and the need for physicians to avoid dual relationships with their patients. In the early 1990s, the College released its important publication Crossing the Boundaries, which reported on sexual intimacy prevalence rates in various studies, and was the impetus for similar studies in many other jurisdictions. These studies served to heighten the profession’s awareness of the concepts of boundaries and boundary crossings.

While complaints statistics show far fewer reports of serious sexual boundary violations since the 1990s, medical regulatory authorities are still dealing with complaints related to inappropriate physical contact between physicians and their patients, such as touching or hugging. When informed of the complaint, the physician may be surprised – even shocked – since the physical contact from his or her perspective was intended to show compassion towards the patient.

Dr. Glen O. Gabbard, a renowned American psychiatrist who has authored numerous books and papers on the topic of boundary violations, cautions that even the most humane or benign interventions, such as a pat on the back, a brief hug or a squeeze of the arm, need to be scrutinized and documented to minimize the risk of misinterpretation by the patient.¹ Physical contact beyond that required to conduct an assessment of the patients or to complete a procedure is never therapeutic. Physicians are reminded that establishing effective rapport with patients, or demonstrating empathy, can be achieved by simple gestures such as eye contact, directly facing the patient rather than a computer, leaning in, and listening carefully and reflectively.

It is never acceptable to make hugging patients a routine part of your practice, regardless of the intent or motivation of the patient or physician.

H.M. Oetter, MD

  1. The concept of boundaries in clinical practice: theoretical and risk-management dimensions. Gutheil, T. G. and G. O. Gabbard. Am J Psychiatry. 1993 Feb;150(2):188-96.

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