Fear of Saying No (FOSNO): Setting Boundaries With Our Patients and Ourselves

Cancer is an inherently complex and intense medical condition that often requires prolonged treatment and surveillance over years. Treatments can lead to frequent side effects and anxiety, requiring constant communication and follow-up with patients. Oncologists have the unique privilege of developing close relationships with their patients that evolve through the course of their disease.

The advent of newer technology and the changing landscape of medicine have drastically altered how oncologists now manage patient needs. These changes have allowed for much quicker and closer communication but are not without personal and professional challenges. Some may wonder how accessible they can and should be to their patients—essentially, the boundaries they may place to protect their own identities and well-being. An oncologist might wonder how much of their personal contact information they should provide to patients and how often they should be available for questions and discussions when away from the clinic without impairing their relationship. Here, we define and explore the role of boundaries in medicine, and review common ethical dilemmas that oncologists face daily when trying to balance patient care and lives outside of medicine. Although we recognize there is no clear single solution, we will propose possible approaches to setting boundaries and potential pitfalls.

Monica S. Chatwal, MD1,2,3; Arif H. Kamal, MD, MBA, MHS4,5; and Jonathan M. Marron, MD, MPH6,7
  1. Moffitt Cancer Center, Tampa, FL
  2. University of South Florida Morsani School of Medicine, Tampa, FL
  3. James A. Haley Veteran's Administration, Tampa, FL
  4. Duke University, Durham, NC
  5. American Cancer Society, Chapel Hill, NC
  6. Dana-Farber/ Boston Children's Cancer and Blood Disorders Center, Boston, MA
  7. Harvard Medical School Center for Bioethics, Boston, MA

Source: Chatwal, M.S., Kamal, A.H. and Marron, J.M. (2023) ‘Fear of Saying No (FOSNO): Setting Boundaries with Our Patients and Ourselves’, American Society of Clinical Oncology Educational Book [Preprint], (43). doi:10.1200/edbk_390598.