Being a ‘good’ doctor: Understanding and managing professional boundaries is challenging and can lead to stress and burnout

Abstract

Objective The aim is to increase the understanding of non-sexual boundary challenges and potential personal and professional impacts on doctors and medical students. Method We examined peer-reviewed and grey literature and published commentary and cases from Australian health practitioner boards and medico-legal insurance companies. Key ideas relating to the objective of our study were subsequently framed into a narrative. Results Compared to ‘sexual’ boundary crossings, the literature examining ‘non-sexual’ boundaries is scanty, fragmented, and difficult to find. There are gaps in knowledge around the prevalence and consequences of non-sexual boundary challenges and crossings, although the safety and wellbeing of health professionals and patients are of concern. Non-sexual boundary crossings may represent a ‘slippery slope’ to boundary violations. Opportunities for doctors and medical students to access relevant training appear limited. Conclusions We identified several categories of boundary challenges based on context, the nature of the existing relationship, and the type of behaviour. Non-sexual boundary challenges may be related to stress, burnout, and risk for future boundary violations. Future research to investigate the impacts on doctors and medical students in maintaining professional boundaries in their relationships with patients and colleagues, their specific training needs, and the effectiveness of training in reducing work-related stress and burnout is needed.