As a physician or provider, at some point you will likely be confronted with the difficult decision of whether to get involved in treating a loved one or assisting with the medical care of a sick family member. If you choose to get involved, you must also decide the extent of your involvement. Do you treat them yourself? Consult? Act as an advocate? Opinions and situations vary, so the answer is not often simple.
Potential Pitfalls of Treating a Loved One
The American Medical Association Opinion E – 8.19¹ deals exclusively with these issues and in clear terms, states physicians generally should not treat themselves or members of their immediate family. The association listed the following as having the potential for impacting a physician’s personal relationships and professional reputation:
- Compromising professional objectivity
- Emotions may be unduly influenced
- Failure to probe into sensitive areas when taking history
- Avoiding performing intimate examinations such as pelvic and rectal examination
- Anxiety leading to over-treating of family member with the hope of rapid, but potentially unlikely healing
- Potential for negative outcomes leading to family quarrels and disunity.
- The patient may be uncomfortable in telling some sensitive information to the physician who is a family member.
- The medical need of the patient may not fall within the physician’s expertise and training, but because of the need to treat, they may feel compelled to continue treatment.
As stated in an article by EK Fromme², rules about the appropriate treatment of family members are not always sufficient or applicable for every situation. They suggest, outside of the convenience factor, most benefits of treating a loved one can be realized in the role of advocate instead of physician. Their suggestion for those facing this dilemma is to ask themselves what they would do in this situation if they did not have a medical degree. By being mindful of this they can consequently avoid any actions that would require a medical degree.
Questions to Ask Yourself Before Treating a Loved One
As a result of their examination of the issue, Anyanwu, Abedi, & Onohwakpor³ suggest asking the following questions:
- Am I trained to address this medical need?
- Am I too close to obtain an intimate history or to cope with bearing bad news?
- Can I be objective enough to not over-treat or give inappropriate treatment?
- Is my medical involvement likely to cause, or worsen, family conflicts?
- Is my relative more likely to comply with an unrelated physician’s care plan?
- Will I permit any physician to whom I refer a relative to treat said relative?
- Am I willing to be accountable to my peers and to the public for this care?
Partnering with the Designated Care Team
Another common situation related to a physician’s role with family members occurs when the family member is under the treatment of other physicians. Chandra, Bharadwaj & Ward⁴ discuss a case scenario where an elderly man had advanced cancer with uncertain prognosis and was hospitalized. Three of the patient’s children were physicians who interacted with the treatment team. Difficulties arose when the treatment team made assumptions about the roles family members would take in the care of the patient.
The authors suggest the presence of physician family members can be advantageous because of their clinical understanding. However, to avoid potential problems clear ground rules about communication must be established(what is communicated, how it is communicated and with whom) and the role of the physician family member(s). The family member(s) must not intimidate the treatment team, should maintain realistic expectations and always be mindful of their objectivity. The clinical team is responsible to clarify the ground rules and should not assume the physician family member(s) will take on the role of medical team member.
Other Thoughts on This Topic
As noted before, opinions vary on whether or not to treat. The following sample of thoughts on the matter may help with determining your own stance.
Making the case for...
- “No, don’t do it”⁵ http://thechart.blogs.cnn.com/2012/01/09/why-doctors-shouldnt-treat-family-members/
- "Yes, do it”⁶ http://www.jpands.org/vol16no3/christman.pdf
- "Yes, but with some rules”⁷ https://www.healthecareers.com/idsa/article/career/treating-friends-and-family
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1 Virtual Mentor. The AMA Code of Medical Ethics ' Opinion on Physicians Treating Family Members. http://journalofethics.ama-assn.org/2012/05/coet1-1205.html. Published May 1, 2012.
2Fromme EK. What Do You Do When Your Loved One Is Ill? The Line between Physician and Family Member. Annals of Internal Medicine. 2008;149(11):825-831. doi:10.7326/0003-4819-149-11-200812020-00011.
3 Anyanwu, E.B., Abedi, H.O., & Onohwakpor, E.A. Ethical Issues in Treating Self and Family Members. American Journal of Public Health Research, 2014 2 (3), pp 99-102. DOI: 10.12691/ajphr-2-3-6.
4 Chandra A, Bharadwaj P, Ward KT. When Physician Family Members Are Involved in Patients' Care. American Family Physician. http://www.aafp.org/afp/2016/0301/p388.html. Published March 1, 2016.
5 Youn, A. Why doctors shouldn't treat family members. CNN. http://thechart.blogs.cnn.com/2012/01/09/why-doctors-shouldnt-treat-family-members/ Published January 9, 2012.
6 Christman K. AMA attacks physicians caring for their families. Journal of American Physicians and Surgeons. http://www.jpands.org/vol16no3/christman.pdf .Published September 2011.
7 Stephens S. 3 Rules for Treating Friends and Family. https://www.healthecareers.com/idsa/article/career/treating-friends-and-family Published June 12, 2017.