Professional-Patient Boundaries: a National Survey of Primary Care Physicians’ Attitudes and Practices

  • Harry Reyes Nieva
  • Elise Ruan
  • Gordon D. SchiffEmail author



The essence of humanism in medicine and health care is relationships—caring relationships between clinicians and patients. While raising concerns regarding professional-patient boundaries has positively contributed to our understanding and prevention of potentially harmful boundary violations, there is controversy about which types of relationships, caring acts, and practices are acceptable versus cross boundary lines.


To examine primary care physicians’ practices and attitudes regarding acts that have been questioned as potentially “inappropriate” or “unethical” crossing of professional-patient boundaries.


Surveys conducted via in-person polling or electronic and mailed paper submissions from April 2016 to July 2017. We calculated descriptive statistics and examined associations with practices and attitudes using logistic regression.


Random sample of all US primary care physicians who treat adult patients; convenience sample of attendees at medicine grand rounds presentations.

Main Measures

Outcomes were self-reported practices and attitudes related to giving patients rides home, paying for patients’ medication, helping patients find jobs, employing patients, going to dinner with patients, and providing care to personal friends.

Key Results

Among 1563 total respondents, 34% had given a ride home, 34% had paid for medications, 15% helped patients find a job, 7% had employed a patient, 10% had dinner with patients, and 59% provided care to personal friends. A majority disapproved of dinner with a patient (75%) but approved of or were neutral on all other scenarios (61–90%).


The medical profession is quite divided on questions related to drawing lines about appropriate boundaries. Contrary to official and widespread proscriptions against such practices (with exception of dinner dates), many have actually engaged in such practices and the majority found them acceptable.


doctor-patient relationships professionalism ethics primary care 


Author Contributions

All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Reyes Nieva and Schiff

Acquisition, analysis, or interpretation of data: All authors

Drafting of the manuscript: Reyes Nieva and Schiff

Critical revision of the manuscript for important intellectual content: All authors

Statistical and geospatial analysis: Reyes Nieva

Administrative, technical, or material support: Reyes Nieva and Ruan

Study supervision: Reyes Nieva and Schiff

Funding Information

This study was funded by the Arnold P. Gold Foundation and the Lucian Leape Family Foundation. The study funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5543_MOESM1_ESM.docx (2.3 mb)
ESM 1 (DOCX 2341 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Harry Reyes Nieva
    • 1
    • 2
    • 3
  • Elise Ruan
    • 1
    • 4
  • Gordon D. Schiff
    • 1
    • 2
    Email author
  1. 1.Division of General Internal Medicine and Primary CareBrigham and Women’s HospitalBostonUSA
  2. 2.Department of Medicine Harvard Medical SchoolBostonUSA
  3. 3.Department of Biomedical Informatics, Columbia UniversityNew YorkUSA
  4. 4.Montefiore Medical CenterBronxUSA

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