The opioid crisis has led to myriad state laws restricting physician opioid prescribing.1 This increased scrutiny, combined with heightened attention to other controlled substances like benzodiazepines and gabapentinoids implicated in some overdoses,2 has heightened anxiety for many physicians around prescribing these medications. Though these tightened standards may be appropriate, we have observed that many physicians lack the comfort and skill needed to set firm yet compassionate boundaries around prescribing controlled medications. When faced with direct requests for these medications, physicians may feel caught between their impulse to avoid harm on one hand, and their desire to heal, to satisfy patient preferences, and to avoid conflict on the other. The discomfort resulting from these competing impulses can drive physicians across specialties to unconsciously respond in ways that may undermine the physician-patient alliance, especially if they react dismissively without expressing empathy.