Maintaining professional distance.

L of seeing patients, I ran into my first patient on a downtown street. The probability of this “chance” meeting would have been strikingly lower in New York City or Washington, D.C. When a colleague or co-worker develops a medical problem, the options for acquiring a caregiver are often dramatically greater in a large city than they are in a small town. More often in a small town, the patient may consult someone they work with, or someone they “know” (socially). We are all taught the importance of maintaining boundaries, and this is emphasized in psychiatric training. Depending upon your definition of what is “proper” and what is not, this concept may be challenged by working in a small town. Finally, we expect caregivers to remain well and, by and large, to rarely need to assume the status of “patient.” When a caregiver requires medical attention, the issues involved in treatment can test the principles of the physician and often engage his or her emotional feelings as well.