A friend wants an appointment in your office for an eye exam. Your grandmother shows you your uncle’s arm tremors at a family gathering. Your child’s friend’s father asks about his child’s flu-like symptoms, groaning about the pediatrician’s copay.
The idea of doctors treating family and friends is a comfort to some, a source of anxiety to others. As a physician, anyone you have a personal relationship with could ask for your medical opinion about their health. You may find yourself pressured to write prescriptions, sign forms or even criticize other doctors.
Doing so can lead to any number of potential consequences, depending on the medical issue, your relationship and the personalities involved. Should you help, or should you avoid mixing the personal and the professional? Here are some insights to help you decide.
The benefits of treating friends and family
Sometimes, taking on the medical care of friends and loved ones leads to better outcomes. Friends and family members can be overwhelmed by hospitals, and your clinic can provide a safe “home base.” Some may not completely trust doctors—your encouragement could be the prompt to get that screening test or take medication. You may also want to make sure that all of the details are taken care of when it comes to the health of people you care about. And when you and your staff are in the position to follow up, you can be more assured that everything gets done.
The risks of treating friends and family
Even with good intentions, though, you can face problematic conflicts or even legal complications when providing medical care for friends and family.
For example, you might hear only part of the story. This happened to me when an acquaintance told me that her doctor was ignoring her concerns. She shared just enough to lead me down a path to an incorrect diagnosis during an off-the-cuff conversation. When she told her physician my diagnosis, he was considerate enough to call me and explain a huge part to her story that she neglected to mention. Fortunately, there was no harm to her health, but her diligent physician’s precious time was wasted—and I learned to avoid her.
At the extreme end, you may find yourself in peril when it comes to accepting friends or family members as patients in your practice. When a colleague’s friend made an appointment for neck pain, the friend altered the treating physician’s report to strengthen a disability claim. Forgery was suspected because the language was inconsistent with medical terms the physician typically used. After some awkward questioning, it emerged that the patient believed that the physician wouldn’t “call him out” because of their friendship. The physician never signed the false report and was not held responsible, but this could have turned out badly had the doctor been suspected of any dishonest behavior.
Deciding where to draw the line
You may receive some astonishing requests from friends or family—and you might jump in to help with some while avoiding others. If a friend has a 105-degree fever and is vomiting blood, you will undoubtedly offer your advice, telling her to seek prompt medical care in a hospital. But if your friend with chronic abdominal pain is trying to get narcotics, you will not want to get involved. Similarly, if your family member is trying to put words in your mouth because he believes that he doesn’t need to do anything about his high cholesterol, you may feel trapped or concerned that your words will be misconstrued to implicate you in his bad choice.
Unfortunately, it’s impossible to predict the situations you might encounter as a physician in a social or family setting—and you may need to decide on the spot what to do about sticky situations. As noted in Current Opinion in Anesthesiology, the ethical dilemma concerning whether doctors can treat friends and family comes up frequently, but there aren’t any clear rules about what to do. While it’s not illegal to provide medical care for your friends and family members, you and your patient have to abide by all the billing and documentation requirements you use with other patients. This is why every physician needs to learn how to set boundaries without harming relationships.
An article in Narrative Inquiry in Bioethics reports that most physicians struggle to balance roles when providing medical care for friends or family members. You may be convinced that your involvement will improve the outcome if a friend or family member can’t communicate with medical professionals due to a language barrier or cognitive impairment. But when you sense that a friend or family member wants to use your relationship to convince you to bend rules, then you’re better off stepping away.
When it comes to saying no to a friend or family member, you can explain that policies govern patient appointments, insurance payments and prescriptions. This is one time when the thorny rules of healthcare can help protect you!
How to maintain responsibility when taking on care
If you do take on the responsibility of providing medical care for your friend or loved one, you will want to maintain professionalism and set boundaries. For example, if you see your patient/neighbor at the store and mention that he needs an X-ray, he may assume that you will schedule it. But if this task is typically taken care of by your clinic coordinator, then your friend needs to go through that process to get the test scheduled. Make sure that consistent protocols are followed, even for patients who are your friends or family members.
Doctors treating family and friends can be beneficial, but it can get sticky. Constructing a few guidelines for yourself can help you avoid situations that endanger a relationship—or even your medical license.