Defining professional parameters can be especially complex and confusing for doctors in training. What counts as too close so that professionalism is lost? What counts as so removed as to lose the special connection that defines the physician–patient relationship? The blurry state of boundaries is underlined in our time by shifting role expectations and the importance of patient autonomy. Physicians owe patients clarity as to what they will or will not do, and patients must be clear with their physicians about their own values and limits.

In this section we stress three of the most difficult boundaries to establish in the physician–patient relationship. They define boundaries of professional parameters. Might sexual relations initiated by patients be justified? What are appropriate responses to sexual innuendoes? How to handle the common complaint about investing emotional energy in difficult patients? Is losing compassion inevitable?