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November 1, 1995

Boundaries in the Physician-Patient Relationship

Author Affiliations

Rutgers University New Brunswick, NJ

JAMA. 1995;274(17):1346. doi:10.1001/jama.1995.03530170025024

To the Editor.  —The article by Drs Gabbard and Nadelson1 on professional boundaries in the physician-patient relationship correctly states that boundary issues have probably been most extensively addressed in the psychiatric literature. Perhaps the most serious boundary violation occurs when a therapist abandons his or her fiduciary responsibilities by entering into a sexual relationship with a patient. Consequently, throughout their article, Gabbard and Nadelson stress the theme of sexual misconduct both explicitly and implicitly. It is in the latter regard, where insinuations of possible sexual impropriety are raised, that their exposition is particularly troublesome.Unethical practitioners with sexual intentions in mind might begin to pave the way by any of the following: making inappropriate personal revelations, scheduling the patient at times when nobody else is present, prolonging the therapy sessions, using suggestive language, arranging meetings outside the office, offering services above and beyond the call of duty, greatly reducing

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