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November 1, 1995

Boundaries in the Physician-Patient Relationship

Author Affiliations

New York, NY

JAMA. 1995;274(17):1345-1346. doi:10.1001/jama.1995.03530170025023

To the Editor.  —Drs Gabbard and Nadelson1 have performed a valuable service by keeping a sharp focus on the critically important issue of patient exploitation by health care professionals. Despite their many cogent and compelling points, particularly concerning sexual abuse, they have made two significant errors, one in logic and the other factual. The error in logic involves the "slippery slope" argument, which can be summarized as follows. Sexual exploitation of patients by physicians is usually preceded by other behaviors (eg, selfdisclosure); therefore, physicians who engage in such non-sexual "boundary violations" are likely to exploit their patients sexually. The specific factual error has to do with self-disclosure itself: "Even if revealing personal issues to a patient does not lead progressively to more extreme boundary violations, self-disclosure is itself a boundary problem because it is a misuse of the patient to satisfy one's own needs for comfort or sympathy." No

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