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A Piece of My Mind
September 25, 2013

Crossing Boundaries—Violation or Obligation?

Author Affiliations
  • 1Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women’s Hospital; and Harvard Medical School, Boston, Massachusetts
JAMA. 2013;310(12):1233-1234. doi:10.1001/jama.2013.276133

It is 5 pm on Friday afternoon. After 2 hours on the telephone trying (and failing) to get her insurance plan to pay for her medication refill, I reached into my pocket and handed the patient $30 so she could fill the prescription. It seemed both kinder and more honest than sending her away saying, “I’m sorry I can’t help you.” While I hardly expected a commendation for such a simple act of kindness, I was completely surprised to find myself being reprimanded for my “unprofessional boundary-crossing behavior” after the resident I was supervising shared this incident with the clinic directors. This allegation of an ethics violation was not only personally painful; it also raised important, controversial, and timely questions about appropriate professional roles.

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