It’s common knowledge among physicians that, except in a few specific circumstances, they should not attempt to treat themselves or their family members. What many might not realize is that the reasons for this apply equally to treating friends. A physician expert outlines these hazards and provides suggested responses to keep friendships intact while making sure your friends gets the care they need.
The AMA Code of Medical Ethics provides additional guidance on dealing with care requests from friends and relatives, such as opinion 1.2.1, “Treating Self or Family,” to help physicians treat themselves or members of their families in the limited circumstances when it is acceptable to do so.
Following are highlights from an article in AMA Journal of Ethics® (@JournalofEthics) by Horacio Hojman, MD, assistant professor at Tufts University School of Medicine, based on a hypothetical case of a surgeon who is asked by a friend to operate on him.
Objectivity and other concerns
“First and foremost, patients deserve objectivity from their doctors,” Dr. Hojman wrote. “When a physician is emotionally involved with a patient, that physician’s objectivity can be called into question.”
It does not matter, he noted, whether a physician is perceived by himself or anyone else as the best in town in his specialty—he still might not be the best physician for his friend. The issue is that humans are known to have blind spots in recognizing their own biases or limitations.
For example, the friendship might prevent the physician from asking personal questions about his friend’s medical history or make him feel uncomfortable about performing a complete physical exam. Likewise, the friend could be reluctant to reveal sensitive information and might even provide outright false information.
Also, friends often know each other’s families, which could result in confidentiality and trust problems.
“Under normal circumstances, physicians can avoid disclosing information to family members by just invoking the patient’s right to privacy,” Dr. Hojman said. But this could be difficult for the physician since his friend’s wife might easily approach him as a trusted friend.
Furthermore, surgical procedures can result in serious complications. These obviously could be tragic for the patient, but they also could have devastating emotional consequences for the surgeon.
What to say
There are several steps to take to minimize potential harms to the friend and to preserve your relationship:
Politely decline. This would include tactfully explaining your concerns.
Offer other forms of assistance. This could include helping the friend find another qualified physician or otherwise navigate the health care maze. Illnesses can be distressing and frightening, and your knowledgeable advice may be invaluable.
In an emergency, agree to do it. Guidelines from the AMA, the American College of Physicians and other professional associations make exceptions for emergencies and for when no other qualified physician is available.
More help here
The CME module, “Boundaries for Physicians: The Code of Medical Ethics,” is enduring material and designated by the AMA for a maximum of 1 AMA PRA Category 1 Credit™ (CME information and disclosures). The module will help physicians identify and understand how to maintain boundaries with their patients and boundaries for treating family, self and colleagues.
