Should Doctors Examine, Diagnose and Treat Their Family Members?
In a 1991 study of physicians published in the New England Journal of Medicine:99% of 465 physicians surveyed had requests from family members for medical advice, diagnosis and treatment.
Family members included spouses, children, parents, siblings, nieces, nephews, in-laws, aunts, uncles and cousins. Eighty-three percent of physicians had prescribed medication for a family member, 80% had diagnosed medical illnesses, 72% had performed physical examinations, 15% had acted as a family member's primary doctor, and 9% had performed surgery on a family member.In addition, 152 (33 percent) reported that they had observed another physician "inappropriately involved" in a family member's care, and 103 (22 percent) had acceded to a specific request about which they felt uncomfortable.
The American Medical Association Medical Code of Ethics Opinion 8.91 (1993)"Self-Treatment or Treatment of Immediate Family Members" states the following:
Opinion 8.19 - Self-Treatment or Treatment of Immediate Family Members
Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination. Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member. This discomfort is particularly the case when the patient is a minor child, and sensitive or intimate care should especially be avoided for such patients. When treating themselves or immediate family members, physicians may be inclined to treat problems that are beyond their expertise or training. If tensions develop in a physician’s professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.
Concerns regarding patient autonomy and informed consent are also relevant when physicians attempt to treat members of their immediate family. Family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. In particular, minor children will generally not feel free to refuse care from their parents. Likewise, physicians may feel obligated to provide care to immediate family members even if they feel uncomfortable providing care.
It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available. In addition, while physicians should not serve as a primary or regular care provider for immediate family members, there are situations in which routine care is acceptable for short-term, minor problems. Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members.
All of the above was written from the aspect of the physician but what I would like to know is whether if you are or if you might be the family member of a physician, to what extent, if at all, would you want the "doctor in the family" participating in the diagnosis, advice or treatment of your illness? ..Maurice.
posted by Maurice Bernstein, M.D. @ 1:28:00 PM
27 comments
27 Comments:
I have examined my own kids and have referred them to someone else for treatment. My oldest daughter (now 43) had a possible appendicitis when she was little and I had to have my partner examine her.
My middle daughter was being treated by a pediatrician for recurrent otitis with antibiotics. He was, I believed, anti-surgery and I finally took her to an ENT friend. She had constant diarrhea and was close to a failure to thrive. He put tubes in her ears, got her off the antibiotics and she grew six inches in the next six months. She was the tallest kid in her class in kindergarten. She is now 29 and married.
I have been divorced twice. My first ex-wife insisted that I remove her gall bladder. I had my former partner assist. My second ex-wife asked me to take out the gallbladder of her new husband. It was a bit odd but he did well. I told her to tell him that there was no one in the world who would take better care of him.
Anyway, that's my story and I'm sticking to it.
Dr. Kennedy, thanks for your story but how did you feel personally about these requests? Did you give any thoughts about turning them down? How would you describe the pros and cons of a physician diagnosing and treating members of his or her immediate family? ..Maurice.
I am going to agree with the majority of the AMA code of ethics. Though to add my own personal experiences my father has invited me to help in his plans for weight loss and I feel as though I have very much helped him in making a positive lifestyle intervention. Diagnosis certainly presents troubles as a family member may be more or less likely to consider a very serious illness for someone so close, and of-course prescribing restricted substances is also an ethical no brainer. Still, in a good primary care settings a large amount of work goes into educating patients about healthy behavior, and if anything this kind of advice from a family member who is also a physician may be superior then that of someone who has a much less intimate relationship. I am much more invested in the health of my father and have had no issue politely though consistently encouraging him more often than might be achieved in a typical outpatient setting. While I also feel that he may be more likely to take my advice because I am not just some health care provider repeating the same "get fit" lines.
-MS3
I think the AMA Medical Code of Ethics Opinion 8.91 is stupid. Does a MD who I've never met before actually give a crap about me, whether I live or die? I'm just #23 out of the 30 patients they see today. But a family member MD, well yes they actually care about me. That translates into better medical care.
"But a family member MD, well yes they actually care about me."
But does that "caring" include avoiding unpleasant or intimate issues in taking a history, avoiding intimate examinations and avoiding uncomfortable and unpleasant testing procedures? These elements of "caring",very naturally parts of family member interaction, will alter the standard, accepted and thorough investigation of a patient's illness. The outcome of such a familial "caring" may be not for the true benefit of the patient. The same concerns exist in the Very Important Person management by one physician of the illness of his or her professional physician colleague. Truly "caring" to do the best for the family patient by using all one's professional skills may not be fully accomplished by the doctor in the family. ..Maurice.
I can think of a few good reasons behind the rationale that physicians should not treat family members. They have enough emotional investment in treating their regular patients (if they're the kind of physician who has such); I'd imagine that would be upped greatly if the person on the other side of that proverbial stethoscope was a relative. How would a physician be able to live with him/herself if something awful--or fatal--happened to a family member? They might also be too prejudiced by certain things they know about that relative to have truly sound clinical judgment, which would be a highly negative influence on the utility of the physician/patient relationship. My advice to relatives if I had managed to become a physician would have been something along the lines of "call your own doctor".
Any truly good physician has a healthy dose of compassion for patients, which is not dependent at all upon whether the patient is somehow related to them. Anonymous at 8:22 has apparently never had a satisfying experience as a patient; physicians worth their salt don't treat patients as "just #23". I personally have had encounters with a couple of not-so-great ones in the patient relations area, as well as a couple who were outstanding examples of what it means to be a physician worthy of the calling. And none of them were related to me.
Are there any states that strictly forbid the treatment of immediate family members or is this subject relegated to interpretation of the code of ethics?
Thanks,
CK
Treating a family member, or another physician, can be problematic. Objectivity is lost and future relationships are at stake. Physicians who are treated by colleagues are at risk 'VIP Syndrome', where inferior care results from short cuts and deviations from established medical practices. See http://bit.ly/a9LZgv
on medical burnout decides to give my daughter anti depresants while they are at her house. My daughter is fighting with her son and Dr.mom calls me and says I do not know what to do I gave these to her and she has been in bed for three days. I speak to my daughter and all is settled come home and be with me and grandma. You are to young to be in a situation like that. I was not happy with pills being handed out like candy by doctor mom. My daughter is packed and I am going to get her and she calls and says do not come and get her she is staying with her boyfriend you cant tell me what to do mom I don't live with you anymore. She had just spent three weeks with me. This is not my daughters normal personality. Then Dr.mom who is unemployed...still on disability writes a letter to me. I have only met twice now. You are uneducated and ignorant you do not deserve a daughter I am going to do everything I can to keep her away from you. Signed Dr.___ ___ ___ MD. Blah Blah Blah but she is on medical burnout for interfering with paramedics at an accident scene which ended in a lawsuit negligence causing death. She also tripped in a department store while on disability and sued the store for thirty thousand she got for her ethical behaviour. Then applied for a government grant to retrain and prove she can be a Doctor again serving the unsuspecting public. Should Doctors treat family or their kids friends out side of an office environment . Because they paid up their money to keep their certificate of a member in good standing. Am U ignorant or just un educated because I think that this is not right? It certainly is not ethical. I am a hard working single mom. Non smoker non drinker do not touch drugs or pills. The ones who prescribe get away with acting like this? If I acted like that I would be in jail.
I feel that doctors should never treat family members unless it is an emergency. My ex-doc is in mental health and treated family members both for mental health issues and issues that weren't in the realm of the board certification. There were drugs suggested to me controlled substances written for ADHD and there is NO medical documentation of any treatment. Try going to the next physician with THAT kind of history to follow up on. This has affected the children psychologically and too many boundaries were crossed. NEVER, NEVER, NEVER do it. LMLNOW
The following was written to this thread today. I am posting it below but without the identifying the writer's apparent real name to protect her privacy in case a visitor knows her. ..Maurice.
I am wondering whether the conduct of my medical partner is suspect. She is treating her entire family in our clinic including her husband, mother, father, and sister. She is keeping medical records as she provides their care but sees them for all their medical care. In addition, within less than a month's time all new employees in our clinic are recruited to be her patient. 100% of our clinic employees are treated by her..in addition to employees have have left our employment. I am concerned that this behavior is potentially opening up ethical issues ie fellow employees having too easy access to personal financial and medical documentation. What is your opinion? I have always felt that treating one's family, close friends, and close employees was taboo. She seems to do it all!
well I am the daughter of a physician who SOMETIMES will treat my siblings and I got minor things during of hours. Also my mother is my daughter's pediatrician and has diagnosed and caught conditions others have missed... She will never test beyond her field of practice and be the first to refer out if necessary. some of the above posts mention the history and questioning process as being difficult, that is the one thing I personally feel most comfortable with. Open communication is key. When I was younger and less wise, I went into a party phase, especially during college ( which my mother hated) but I always let her know what I was sitting for the simple fact if something did happen to me she would know what the cause was or have a place to start. Same goes for sexual activity. I feel it harder to tell a stranger doctor about topics like that. With my mom, I have full disclose. This open rapor is very important, and she had made it clear if she can't address the problem, condition, or situation, she will be referring you to someone who can. that's just my opinion.
Anonymous from today October 26 2013, let me ask you this question: if you were a pediatrician and not your mom, would you feel confident and feel comfortable diagnosing and treating you own child using your pediatric knowledge and skills as your own mother may have done with you and your siblings? Would you feel more comfortable treating the children of your daughter as a pediatrician rather than your daughter herself? Can a difference of an additional generation make the family member doctor-patient relationship regarding diagnosis and therapy more professional? ..Maurice.
I am a pediatrician. I have examined, diagnosed and treated my own children. I attempted to put on a pediatrician's hat when I did that and be objective. If I have any doubts I would consult others. I believe it come down to your personalities. Physicians should be aware of the risks and benefits of treating their own family members and make decisions on the case by case basis, instead of follow general rules.
Wearing a "pediatrician's hat" as a parent physician is one thing.. but diagnosing and treating one's child is another thing: not the "hat" but the parent's "heart". The heart, the specific love and parental feelings and responsibilities for their own child can never be discarded and will always challenge the "pediatrician's hat" which the parent is now wearing. ..Maurice.
Hi, I just wanted to add my experience with this topic.
My father is a physician (radiologist) and he 'diagnosed' myself along with my other siblings countless times. When I say diagnose, I mean he took a look, listened to my symptoms, and, if by chance there was a condition or problem that needed to be addressed, he would always send me to the local clinic. He never took it upon himself to prescribe me drugs, or do any other medical procedures. He simply used his knowledge to determine if I needed medical attention or not. Of course if I was sick at home he would keep an eye on me- he always made sure my symptoms were not cause for concern. HOWEVER, when I did break a bone, he took an X-ray and told me which bone had been broken and had one of his colleagues create my cast. I frequently visit my family doctor, and have gone to many specialists as he said he was not going to diagnose me- and he never actually really has.
Thanks,
Peter
Peter, what you write suggests that your father was providing the appropriate degree of professional medical screening for his child. A physician parent should use their knowledge and skills for non-invasive screening but leave it up to another professional to be the one finally responsible for the diagnosis and treatment. ..Maurice.
What about a doctor that is prescribing Adderal or Atteral to his daughter? Would this be unethical?
My husband is a family practice physician. He treats our children, our parents, and most family members that come in to the office. I work in the office as a nurse. We have 6 children, and a very large family.
Our practice is large, 6 providers. Most family will see others but like to see my husband. He is trusted. if something comes up he cannot handle, he refers out. A patient is a patient. Family you just know better. Unethical? I think not. We all respect and trust him.
Always two sides, thanks for reading. A. Miccio
I am a licensed mental health clinician who is just now treating a sister who is currently homeless and has severe medical and psychiatric challenges. Because of her mental illness she has not been compliant with meds or therapy and has been victimized. She is in crisis and is willing to begin this process of treatment, but only under my care to begin with. I am treating her during this time to get her engaged in treatment and then I will refer her. I strongly believe in certain situations we can not turn our backs on family members in crisis
To Anonymous from today:
I fully feel comfortable considering what you are doing as professional. At this point, it is like, despite being a family member, you are essentially providing urgent resuscitation and knowing when to transfer to the care of others.
..Maurice.
If your husband is a Dermatologists , and your problem is not related to skin but mental, is he allowed to give you anti depressant?
The wife should be evaluated and treated by a physician other than her husband. The husband may be a factor in the wife's emotional symptoms and therefore it would be inappropriate, unethical and unprofessional for the physician-husband to be treating his wife. ..Maurice.
I think treatment of family members should be avoided whenever possible, and consider it unethical except in the case of emergencies in isolated situations.
A physician might treat a family member to save money. What, then, shall he or she do if the patient, with whom the physician is financially involved, must be diagnosed with an expensive chronic condition (RA, HIV, MS, clotting disorder, etc.)? The potential for conflicts of interests here is huge.
What about the physician caring for an aging parent? If the physician could declare the parent incompetent to manage his or her affairs, the physician might gain control of the parent's estate. On the other hand, an innocent physician who might diagnose a parent with Alzheimer's, though the dx could be correct, could face unfair accusations of mistreatment by other family members who are somehow threatened by the dx.
Being a physician and sharing one's anecdotal experience, strength and hope with friends and family as a community member is one thing- treating them deprives them of the chance to connect with a health care team that will be there for them regardless of the status of their personal relationships or living situation, and opens the door to many unforeseen tragic outcomes indeed.
Excellent points by Anonymous today. And as reminding everyone by Dr. Kirsch in a comment back in March of 2010, a physician treating another physician or a family member may be opening him/herself to VIP ("very important person") treatment which can include "inferior care" which results from "short cuts and deviations from established medical practices" out of a concern for "comfort" in place of "necessity". Sometimes the "comfort" is strictly for the one providing the care. ..Maurice.
Is it ethical for a family doctor to tell a family member that they have a mental illness without that person asking? This doctor is in an arguement with the family member. They are "diagnosing" the family member with a specific condition and telling them specific drugs to go on. This was all done outside of a medical office. It appears to be a smear campaign where they are using their status as a doctor to discredit the person in the family under the disguise of trying to help the individual.
Friend of the family
Mental illness diagnosis is a bit more complex to correctly diagnose and treat than a simple "runny nose". One of the complexities in a physician who is a family member diagnosing mental illness in another family member is that the physician may him/herself be a personal factor in the development or course of the diagnosis and as such it would be inappropriate to attempt to diagnose and manage the case. Therefore, a physician outside the family should be involved to diagnose and treat.
I hope this answers your concern as a friend who is aware of the family situation. ..Maurice.
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