Difficult Encounters: How to Set Boundaries in the Context of Structural Inequities.

Difficult encounters between patients and clinicians impact all areas of medical care, yet how to manage them is not routinely taught in medical training. This paper presents a case of a patient with cancer who struggled with emotional outbursts and impulsive behaviors. In the context of the racial trauma and socioeconomic challenges that the patient also experienced, the team struggled with boundary setting. We will review both traditional and contemporary approaches to the management of difficult clinician-patient interactions, while also addressing some of the limitations of existing frameworks. We will explore the role of bias in boundary setting and make suggestions for individual-, team-, and system-level approaches.