Return to Humanism

I write this letter as I stand on the threshold of just having finished my psychiatry residency. I want to express my viewpoint regarding an issue that touches us all: boundaries in psychiatry.

During my residency training, I was taught that there are many approaches to handling boundary issues, depending on the training of my supervisors. However, the overall lesson was to maintain a strict demarcation between the patient and the provider; for example, if a patient asked for an appointment other than at his or her usual time, residents were expected to ask a multitude of questions to find out whether the request had some psychological under-pinning or meaning to it. Many times, however, I found that patients simply needed some flexibility in scheduling appointments.

During the last year of my training, I had the good fortune of being treated by a physician who bent a few rules to accommodate my schedule and reintroduced me to the humanity of medicine. I came to realize that bending a few rules, such as being flexible in scheduling appointments or visiting a patient as he or she navigates the terminal stages of life—in short, going above and beyond the call of duty to help patients—does not cross any boundaries. Rather, it identifies us as humanistic caregivers: an image we all should strive to cultivate.