266 Interacting with Their Patients
example, David, the psychiatrist with HIV, strained to guard against
overidentifying with patients who had his ‘‘issues,’’ psychologically.
Doctors’ Problems with Blurred Boundaries
Firmer boundaries may make medicine more straightforward to practice,
but were not always easy to maintain. At times, doctors socialized with
patients, problematizing professional-client relationships. Patients could
then take advantage of the friendship. Patient-friends may call at hours
that are appropriate for friendships, but not for professional relation-
ships. Stuart described the situation thus:
Sometimes the friendship gets abused. Somebody calls on a Sunday
at 7 A.M. and has a question. I’ll ask them, ‘‘Why are you doing
this?’’ They have a reason that I don’t think is very good. So I say,
‘‘ . . . If you behave like a patient, you will get good care. . . . Please
come to my office.’’ Once in a while I’d say, ‘‘Don’t do that
again. . . .’’
Talcott Parsons described roles of doctors and patients in the abstract
(3, 4); when these boundaries eroded, unexpected tensions could arise.
The doctors here struggled to decide how to respond—whether as pro-
viders (with respect) or as friends (with anger).
Physicians faced questions of exactly how close to be with patients—
for example, what to do if they saw a patient in a social context en-
gaging in unhealthy behavior: eating poorly, smoking, drinking, or using
drugs. Physicians could later broach these topics in the office with the
patient. As a result, at times patients opted not to consult doctors they
knew.
Particular dilemmas about diffuse boundaries arose when doctors had
to decide whether and how often to give out their home phone numbers.
Some physicians provided these to patients, while others refused, or did
so only very selectively. Juan and many of his patients had HIV. He said:
I gave my home phone number or pager number to a lot of patients
I identified with and felt needed me. So people paged me in the
middle of movies, or sex. It was hard to keep the boundaries clear.
I thought that if I was in their situation, I would want my doctor
to be that available. So it was hard to say, ‘‘This is unreasonable.’’
The boundaries got very blurred. . . . A lot of times if somebody