Physicians often are asked for advice about medical matters by relatives and friends. This ranges from simply acting as interpreter or facilitator to offering medical advice to providing medical care. This discussion is about the more ambiguous portion of the range of requests from relatives and friends in which physicians are asked to act as informal medical consultants, a topic that has received little attention in the published literature. It is not about issues related to the medical care of family and friends, including prescribing medications, which have been covered well in the literature. Although physicians handle most such requests well, occasionally the requests provoke misunderstandings and conflicts that could be mitigated or prevented by attention to the dynamics of the transactions and adherence to some practical guidelines. SOME RESPONSES TO REQUESTS FOR MEDICAL ADVICE “Yes, of course, I would be happy to help.” “Let me make sure that I understand what you are asking.” “I would be happy to continue to be involved.” “I am happy to help but please understand that [I have not examined you], [I am not a cardiologist], [I am not your doctor].” “I am not your doctor, but in situations like this I believe X is recommended.” “I am sorry, but I don’t think I can do this because…” “Under these circumstances, you should not rely on me for medical advice.” “I would feel better if you asked your doctor about this.” “I am your friend (or cousin, etc.) who happens to be a physician, but I think you can appreciate that that is different from being your physician.” The last response could apply to several of the situations implied in the preceding responses and combined with them. Thus, one might say, “I would be happy to continue to be involved. But remember, I am your friend who happens to be a physician, and I think you can appreciate that that is different from being your physician.” Or “I would feel better if you asked your doctor about this. I am your cousin who happens to be a physician, but I think you can appreciate that that is different from being your physician.” RECOMMENDATIONS FOR RESPONDING TO REQUESTS FOR MEDICAL ADVICE AND HELP FROM RELATIVES AND FRIENDS Be clear about the expectations of the requester and yourself, including whether you are being asked for simple factual information, for your medical judgment, or to be more substantially involved. If for some reason you cannot respond to the request or have concerns, make that clear. In close relationships, such as with a spouse, a parent, a child, or sibling, it is a matter of judgment whether you explicitly express the extent of your initial and ongoing involvement and commitment. Treat your interactions with relatives or friends with the same professional expertise and judgment as you would any patient, even though those interactions may be informal. Document the encounter with a brief note for your personal files, which can be useful if you have continuing interactions with your relative or friend. Be aware that a structured physical examination and especially charging a fee strengthen the establishment of a legal relationship with the requester as your patient. Most requests for medical advice do not require a structured physical examination, but if you choose to examine the patient, you will need to decide whether the examination should take place in your office. Respect the requester’s autonomy and confidentiality and conform to HIPAA requirements where applicable. Be sure the requester approves the sharing of information, even in close relationships. Obtain the patient’s permission if you review medical records or other information. If the requester is speaking for another person, respect that person’s autonomy and confidentiality. Be aware of the potential conflict between your roles as a relative or friend and as a physician. Your professional judgment may be in conflict with your emotional judgment. Further, all physicians play a number of different roles (e.g., doctor, spouse, parent, friend, community leader) which can reinforce or conflict with one another, and we all may benefit by reflecting on this and discussing such matters with colleagues to try to understand better how to avoid conflict and optimize synergy among our various roles. Source
