All in the Family
What to do when you are the doctor, NP or other kind of health care provider and your relative comes to you and asks for a diagnosis, prescription or other kinds of care? Should you treat them or turn them away?
Last week, American Medical News grappled with this thorny ethics question.
According to a 1991 study, nearly every physician (99%) had been asked by a family member for medical advice, diagnosis or treatment. But just because you are asked, doesn't mean you should. 83% had prescribed meds, 80% had provided diagnoses, 72% had done physical exams, 15% had been a family member's PCP, and 9% had performed surgery on a family member.
22% had done something which had made them feel uncomfortable.
So why do so many doctors cross these familial boundary lines? Duty, responsibility, loyalty, a desire to help a loved one. All good reasons in my book. And is there really something wrong with doctors practicing on family members? In my view, if a doctor keeps a chart on their "patient" and is practicing within their area of expertise, I don't see anything wrong with it.
It's when "Auntie Nurse" or "Daddy Doctor" starts prescribing or diagnosing outside their area of expertise that I would start to worry. Or when a doctor themselves says they fall into that 22% of people that feels that they did something that made them uncomfortable. That's when treating family becomes problematic.
Otherwise, I don't see how providing medical care to family is any different than getting your car repaired by your uncle or your taxes done by your nephew. Professional services of all kinds are done by relative all the time. We keep all kinds of things "all in the family" all of the time. I see no reason to treat medicine with any kind of exceptionalism as long as doctors and family members know where the boundaries are in as much as we do with accountants, lawyers and any other professionals.
Summer Johnson, PhD
contribute a comment
Your contributions to the conversation are very much appreciated. We do have a few simple guidelines, though. Be civil. Stay on topic. We reserve the right to remove comments that violate the aforementioned guidelines. One more thing: comments are moderated, so it may take a little while for your comment to be posted. Thanks.
comments
The only problem I can see is that unlike diagnosing a car, diagnosing a person with a distressing illness would be emotionally difficult. You want your doctor to care about you, but not so much that he can't contemplate the hard stuff. I've seen this happen more than once among people of my acquaintance, not with family members but with doctors who were close friends.
I had a neighbor who told the pediatrician, a family friend, that her infant son didn't vocalize and interact with her like his older sisters had. The ped. said, oh well, that's a boy for you! It turned out the kid was totally deaf, and she discovered this in a horrible Helen Keller-like moment that she could really have been spared.
And then I had a friend who almost died of AIDS b/c it just didn't seem to occur to his doctor, a family friend, to check for it. I had been thinking that his symptoms were classic for AIDS for quite some time - bronchitis that turned into pneumonia over and over; unexplained fevers; debilitating diarrhea; but I thought that if it was that clear to me then his doctor must have ruled it out long before. Nope. He seriously was at death's door before he went to another doctor, a stranger to him, and of course was diagnosed right away.
- by Laura(southernxyl) on Apr 20, 2009 at 8:06 PM | link