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Misuses and misunderstandings of boundary theory in clinical and regulatory settings. Additionally, the inherent inequality in the doctor-patient relationship may lead to exploitation of the patient.

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Myers, MDProfessor and director, forensic psychiatry program, University of South Florida College of Medicine, Tampa 1.

Patient-therapist boundary issues: an integrative review of theory and research.

Annotations to AACAP ethical code with special reference to evolving health care delivery and reimbursement systems. Ethics guidelines for the practice of forensic psychiatry.

American Academy of Child and Adolescent Psychiatry code of ethics.

For patients who are significantly disruptive, threatening or considered dangerous for the physician or his/her staff, a much shorter window of time down to and including one day may be appropriate.

Notification should be accomplished in writing sent by Certified Mail with “Returned Receipt Requested” or by regular mail with “Address Service Requested” in the bottom left hand corner of the front of the envelope. Maintaining treatment boundaries in small communities and rural areas. ‘The requirement that the physician conduct himself/herself with propriety in his or her profession and in all the actions of his or her life is especially important in the case of the psychiatrist because the patient tends to model his or her behavior after that of his or her psychiatrist by identification. These requirements become particularly important because of the essentially private, highly personal, and sometimes intensely emotional nature of the relationship established with the psychiatrist. Patient-therapist boundary issues: an integrative review of theory and research. In the latter situation, the physician may be denied a list of names and addresses of his patients to use for communicating that he/she is discontinuing practice in the area.The current American Medical Association (AMA) ethics document on discharging a patient recommends under such circumstances (in consultation with his/her attorney) the physician should provide a model patient termination letter to be given to the party withholding his/her patients' addresses, and request that the addresses and letter be merged for distribution to these patients.It is desirable to provide in the letter to the patient and/or to the patient's responsible party some explanation of the reason for ending the doctor-patient relationship, but the decision to provide or not provide that explanation is up to the licensee.

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