I read with interest the debate between Professors Poole and Cook in this month’s journal. ^{Reference Poole and Cook1} I have been following the exchanges on these two highly polarised positions in the College for quite a while. Not wishing to take a position on the acceptability of praying with patients, I find myself astounded by the inability in some quarters to accept or even recognise the fact that praying with a patient may be as serious as preaching to a patient. Boundaries are set in professional practice to protect both the patient and the doctor. Would a physician feel easy taking stock market tips from their Wall Street banker patient? Or accepting racing tips from their very informed bookmaker patient? How about setting up a business venture with a venture capitalist patient with significant ‘daddy issues’?

Would it be appropriate for a doctor to tell his patient that his Church offers the best chance of redemption, or that she should divorce her cheating husband because this is what is perpetuating her depression? These are all hypothetical examples of boundary violations and are rightly proscribed in all codes of ethics worldwide. In deciding harm in a doctor–patient interaction, surely it is for the doctor to decide where the boundary lies and then to maintain it. The sexual boundary is not the only boundary we should be taught not to cross, although arguably it ought to be the first.

The fact the College has given so many column inches to the issue means that, even if there are no cogent arguments, this matter is something that has immense political clout. Matters are not being helped by letting this issue simmer. We need decisive action. Why can’t the College commission a working group representing all sides of this debate and issue a consensus statement to help believers and non-believers equally to navigate what appears not so much a moral conundrum as political posturing? When I am hauled before the GMC by a patient for inviting him (and encouraging with his ‘consent’) to give up his faith and join me as a fellow God-less person, where will the guidance come from?

It appears that the inequality of power in the doctor–patient relationship has been forgotten in the heat of this debate. God help me and my fellow confused brethren. It looks like we have been hit for six at this boundary.