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Should Doctors Treat Their Family Members

Discussion in 'Doctors Cafe' started by Egyptian Doctor, Jan 2, 2014.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this?

    In 1847 the AMA published its first “code of medical ethics” which covered many subjects and, though short, is dense and diatribe-like. It seemed to me, when I read through it, that it was mainly concerned with discouraging various forms of quackery, which was rampant in the relatively unregulated environment of the early 19th century in the United States.


    We physicians were enjoined to “unite tenderness with firmness and condescension with authority” and our patients were reminded that they needed to do what we told them and not fuss and argue with us. Physicians were required to be always available to sick patients, to get consultation when necessary, to treat those who could not afford to pay. In turn, patients were told to avoid seeing more than one doctor because we might disagree and then there would be dissension within the profession. Physicians were to be of superior moral character, not advertise, not have patents on surgical instruments, be cheerful and treat each other and each others’ family members for free. It was noted that if we were to treat our own family members, we would be apt to be timid and irresolute.

    The American College of Physicians published its 6th ethics manual last year and said this about treating family and friends:

    Physicians should usually not enter into the dual relationship of physician–family member or physician-friend for a variety of reasons. The patient may be at risk of receiving inferior care from the physician. Problems may include effects on clinical objectivity, inadequate history-taking or physical examination, overtesting, inappropriate prescribing, incomplete counseling on sensitive issues, or failure to keep appropriate medical records. The needs of the patient may not fall within the physician’s area of expertise . The physician’s emotional proximity may result in difficulties for the patient and/or the physician. On the other hand, the patient may experience substantial benefit from having a physician-friend or physician–family member provide medical care, as may the physician. Access to the physician, the physician’s attention to detail, and physician diligence to excellence in care might be superior.

    Which leaves me ethically stranded about where I was before. It is wonderful to be able to provide medical care to friends and family. When I look at what a patient has to go through when they have any one of a number of very common symptoms, a rash, vaginal itching, urinary discomfort, an upset stomach, a productive cough, and the eventual outcome, often an unnecessary antibiotic after a wait of several hours, with almost no history taken and precious little planned followup, I cringe. Can I do better than that for someone I know well and love? Yes. I can.

    And yet.

    It is not uncommon that the easy problem that I can take care of in no time leads to another problem and then I may not be available. Then I have treated the patient but left no easily accessible record to help the next care provider figure out what’s going on. And sometimes I give really good advice, but the patient doesn’t believe me because I’m not really their doctor. Then they do some wrong thing and come back to me for advice when that doesn’t work and I am annoyed because they didn’t listen to me in the first place and I’m now doing something else important and for annoyance of this magnitude I really should be paid. And sometimes my familiarity really does cloud my judgement. I don’t insist on actually seeing them and miss a very important piece of information that I would never have ignored in a patient in my office.

    I have provided hospice care for close friends and family. I think that worked out very well, and I can’t imagine standing by watching communication snafus worsen the pain of dying. And yet it was pretty tricky. My heart strings were pulled and decisions really were more difficult than they would have been had I not been so intimately involved. My children have not had much experience with being doctored in the way that has become standard in our culture. But much of what is now done in doctors’ offices has traditionally been the job of a mother, including managing the countless colds and tummy troubles that plague children and the inevitable bumps, bruises and lacerations. When I meet the children of physicians, they speak proudly of how their physician parents hydrated them, placated them, benignly neglected them. It is what is most often done, at least with really healthy children. I have traded uncomplicated medical care of close friends for jars of honey or gratitude or just the satisfaction of knowing that the right thing was done, all so far with no ill effects.

    I have also refused to treat people close to me for issues that were complex or required prescriptions for controlled substances, or when my relationship with them was one which made the blurring of roles a bad idea.

    I salute the American College of Physicians for the final two sentences in the paragraph about treating those with whom one has a prior relationship. They didn’t have to recognize that care of family and friends can be “substantially benefi(cial)” to both the patient and the physician. I can just imagine the arguments that may have accompanied this as the document was written. It is as deeply ambiguous as the subject it addresses.

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    drshima and Dr Felicia like this.

  2. Dr Felicia

    Dr Felicia Active member

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    My personal opinion is that especially in serious cases doctors shouldn't treat their family members because there will be some more than average emotions between the doctor-patient relationship and the doctor's decisions might be influenced by that.
     

  3. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    One of my friends has Erb's Palsy cause of his delivery.
    He was delivered by his father who was a gynecologist.
    His father left medicine after this problem.
     

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  4. Alex132

    Alex132 Active member

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    i don't think it would be a good ideea to treat family members...you need to take all your decisions based on logic knowledge and experience...but once you have to treat a family member there will be feelings...and really...we as doctor's need to stay away from our feelings...of cours you get in the med school with the ideea that OMG i will be the best and i will take care of everyone and i will be the kind of doctor who really cares about my pacients problems...but then in the 1st year you learn prety fast that if you care that makes you a bad doctor...we canot have feelings for anyone we treat...we need to be cold-minded...to see them as a human body that has something going wrong...cuz if you stop and think about it no one would want to see their loved once suffering because a treatment...or to see that loved ones could die because of the treatment..and them maybe we wont make the best decision ..my oppinion ^_^
     

  5. emanuelcortes

    emanuelcortes Young Member

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    I have an uncle who´s specialized in Surgery..his brother was shot several times during a robbery..he was the only one available at the hospital where they took his brother..after more than 10 hrs of surgery he could save his life.. I think it all depends on the personality of the MD and how he can manage such traumatic situations. In my case, I think I would just freaked out !!
     

  6. Rodrick Lwando

    Rodrick Lwando Famous Member

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    1. I think the level at which medical care should be provided by a parent-doctor or friend-doctor matters!!!

    2. At some point a doctor should provide medical advise to the family members and friends. Being a doc doesn't mean that your own friends and family should be deprived of your medical support and first aid, for example...

    3. Like I said the level at medical care should provided matters. If the medical condition of the patient who is a friend or a family member is solemn, that doc who is related to such a patient should step back...
     

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