From Detached Concern to Love: Reconsidering Physician-Patient Boundaries

Developing appropriate professional boundaries is part of becoming a mature clinician. Boundaries help physicians fulfill their duties in relationally complex and emotionally fraught situations. The concept of "detached concern" has been used to characterize physician-patient relationships in which physicians show empathy and concern while maintaining due emotional distance. However, if the default tendency of trainees and clinicians is toward detachment, then emphasis on professional boundaries may do less to promote proper detachment than to diminish human connections with patients, thereby leading to clinician disenchantment and patient dissatisfaction. The authors propose that the physician-patient relationship is better characterized by love-specifically the kind of ordered love described by the fourth- and fifth-century bishop and philosopher Augustine of Hippo. Augustine's vision of love has influenced many social reformers through the centuries, including, notably, Martin Luther King Jr. Importantly, such love is consistent with safeguards for which professional boundaries in the clinical context are corollaries, including guarding against forms of compassion that interfere with reasonable judgment, acknowledging humans' finite capacity to love, and recognizing potential harms of disordered love. Against a horizon of love, however, such boundaries are transformed from walls that prevent human connection and concern to walls that create spaces for and encourage any human connection that does not hinder healing and the patient's good. By shifting their emphasis from detached concern to love, medical educators can re-enchant medicine for trainees by encouraging the human connections that make the practice of medicine its own reward.