AMA Report (4) Peers as Patients

The subject 4 Peers as Patients is one of a series of 8 Reports of the Council of Ethical and Judicial Affairs (CEJA) of the American Medical Association. These reports have not yet been adopted as AMA policy; they will be discussed and debated in June 2008. If they receive the support of the majority of the delegates from the state and specialty societies, they will become policy. Anyone, including the general public, can provide testimony on CEJA reports either in person at the meeting or by writing to ceja@ama-assn.org.

I am presenting each Report as a separate thread on this blog. By clicking on the link above, you can gain access to the specific wording of the Reports, 1 through 6 are to be Amendments to the Constitution and Bylaws of the American Medical Association. Reports 7 and 8 are for Informational purposes. Why should the public be interested in these reports? They are part of the ethics of the system of medicine in the United States and may be reflected elsewhere in the world. Through the practice of medicine by all physicians, the rules presented in these reports can be applied to and may affect all patients. You may write directly your comments to CEJA at the e-mail address above and, of course, you are certainly welcome to post your comments on this particular Report here.

The issue of peers as patients is one where a physician is responsible for the management and care of another physician who may be unknown to the treating doctor or who may be a colleague in the same office, same hospital or a known physician in the same or different specialty. It could also involve a resident in training being cared for by or actually treating the resident’s supervisory physician. In fact, it may be that a medical student might be involved in the team caring for another medical student or a resident. In virtually all of these relationships, there are factors both emotional and practical and professional which make the therapeutic relationship different than that related to the usual non-peer patient. (Similar factors are involved if a physician attempts to treat a close member of his or her own family.)

The Report notes 4 areas of ethical concern which are extracted here:

Clinical Objectivity. Treating a physician-patient who is a also a close personal friend raises concerns… notably the possibility that the treating physician’s professional objectivity and medical judgment may be affected by his or her emotional ties to the patient, thereby interfering with the care delivered. Moreover, as this Opinion also notes, when the patient is a colleague, physicians may fail to probe sensitive areas in taking the medical history or may fail to perform intimate parts of the physical examination. Fairness is also a consideration in making treatment recommendations or providing care to a professional peer. When preferential treatment that other patients do not standardly receive for the same clinical indications is given to—or expected by the physician-patient—it may result in an uncomfortable and confusing situation.4 Although it is human nature to treat differently someone you know personally or feel a professional kinship to, physician-patients should not receive disproportionate attention and resources beyond what is appropriate to meet their medical needs.

Informational and Physical Privacy.
Concerns about the privacy of their personal health information have been cited as a reason physicians delay seeking medical attention.4 Physician-patients may be uncomfortable disclosing sensitive information, much in the way friends or family members of the treating physician might react. …Respecting modesty and physical privacy is important for any patient. When the patient is a professional colleague, particularly one who works in the same health care setting, special attention may be required to ensure that his or her physical privacy is respected

Informed Decision Making.

When physicians undertake the care of a colleague they may assume that the physician-patient has a good medical knowledge base and that they need not fully explain the condition or plan of treatment.4 It is important that an open dialogue take place in which a physician-patient and the treating physician discuss the condition at hand. The treating physician should keep in mind the physician-patient’s general medical background but make no assumptions on the depth of his or her knowledge about a particular disease, especially one outside the physician-patient’s specialty area.

Effects on Professional Relationships

Providing medical care for a peer may also lead to tensions in a physician’s professional relationship with that individual. For example, a negative medical outcome or disagreement over best course of treatment may have disruptive effects on the parties’ working and personal relationships with one another.

The Report makes the following Recommendations:

(1) Physicians who provide care to a peer should be alerted to the possibility that their professional relationship with the patient may affect their ability to exercise objective professional judgment and make unbiased treatment recommendations. They must also recognize that the physician-patient may be reluctant to disclose sensitive information or permit an intimate examination.

(2) Physicians providing care to a professional colleague have an obligation to respect informational and physical privacy of physician-patients as they would for any patient. Treating physicians should consider, and possibly discuss with the physician-patient, how to respond appropriately to the inquiries about the physician-patient’s medical care from other physicians or medical staff. Treating physicians should also recognize that special measures may be required to ensure that the physician-patient’s physical privacy is respected.

(3) Physicians providing care to a colleague should respect the physician-patient’s right to participate in informed decision making. Treating physicians should make no assumptions about the physician-patient’s knowledge about her or his medical condition and should provide information to enable the physician-patient to make voluntary, fully informed decisions about care.

(4) Physicians in training and medical students face unique challenges when asked to provide or participate in care for peers given the circumstances of their roles in medical schools and residency programs. Except in emergency situations or when other care is not available, physicians in training should not be required to care for fellow trainees, faculty members, or attending physicians if they are reluctant to do so.

In what other ways do you think doctors treating other doctors might affect their therapeutic relationship and even affect how the doctor at the time treats his or her non-peer usual patient? Go to the link above to read the full Report. ..Maurice.