Lively discussion, personal reflection, and creative solutions filled this workshop for both physicians and spouses. Although more common in rural locales, medical practice in any socially interconnected community results in the physician treating friends, neighbors, colleagues, and others with multi-dimensional relationships. Although not often discussed in medical training, the issues of relationships and boundaries are lived every day and are crucial to the happiness of physicians, spousal partners, and their families. Risks of multi-dimensional relationships between doctor and patient include omission, breaching confidentiality, assumption, loss of objectivity and blurred boundaries. Omissions can be by the doctor who feels uncomfortable asking about a particular aspect of history, or by the patient who feels uncomfortable divulging certain personal information to a physician who is known in another role, perhaps as a close family friend.
Breaches of confidentiality can easily occur.
Assumptions can be made either by the patient or by the physician when they know each other well outside the office in other roles. Loss of objectivity is also difficult, especially around serious illnesses. Not only the physician, but also the physician s family must live with the consequences of patient health outcomes. Finally, and most importantly, multi-dimensional relationships are at an increased risk for blurred personal and professional boundaries especially when there is more access to care outside usual working hours. Challenges for physicians spousal partners were also discussed.