Physicians Can Treat Family Members or Friends

Antonio Abbate, MD, PhD is the James C. Roberts, Esq. Professor of Cardiology in the VCU Pauley Heart Center and vice-chair of the Cardiology Division in the Department of Internal Medicine, Virginia Commonwealth Univeristy, Richmond, VA. He is the author of “Ethical Challenges in Treating Family and Friends,”10 a comment in response to the article by Gold et al.

What are your perspectives on treating family and friends?

Dr Abbate: I think there are cultural differences in the approach to this issue. In Italy, where I come from, it is very normal to treat family members and friends. In fact, it’s not only normal, but also expected. In fact, in medical school, we were told to treat our patients as if they were our parents. This strikes me as a paradox, because how can we follow that if we can’t treat our parents?

When I came to the United States, it was a cultural shock to encounter opposition to treating family and friends. I have spent a good deal of time talking with colleagues and examining this issue and have come to the conclusion that there is no “right” or “wrong” answer to this, just different ways of looking at the same complex problem.

Do you think physicians should offer medical care to relatives or friends who are not their patients?

Dr Abbate: It is a common scenario that people ask each other at parties or other social gatherings about their professions and sometimes seek advice. “Oh, you repair roofs? My roof might need repair.” Physicians get plenty of these types of questions. I think it is okay to chat about medical issues, so long as you are not giving specific recommendations or writing prescriptions. Writing prescriptions for someone who is not your patient is unsafe and perhaps should even be illegal. But these informal settings can be great venues to advocate for healthy living, screenings, and similar things.

Do you think physicians should accept relatives or friends as patients?

Dr Abbate: I do not see a problem in doing this, but I think that there must be a real doctor-patient relationship. Treatment should take place in the office, not in other settings, and there should be a chart involved, documentation, follow-up, communication with other family members if appropriate, and all the formal structures that would apply to any other patient. This puts both people in a right framework and offers legal protection as well as appropriate clinical care.

Do you think that treating relatives or friends impairs a physician’s objectivity?

Dr Abbate: I think that it is possible to lose objectivity with many people, not only family and friends. The moment we enter the exam room and see the patient, we may have a bias about their lifestyle, characteristics, or preferences, perhaps unconsciously. Theoretically, that could put our diagnosis or treatment plan at risk. But as good physicians, we learn to take those biases into account and challenge them to arrive at a solid diagnostic approach. In the end, the literature on ethics is clear that physicians have the ultimate say in what they are and are not comfortable with. If they feel they cannot be objective, they should feel free to say they cannot care for the patient, whoever that patient might be.

I want to clarify that I am not saying that every doctor should be comfortable taking care of family members or friends, or that there may never be loss of objectivity. This is where you have to decide if you have confidence in your professionalism and objectivity. If you are concerned, then you should not treat that patient.

Do you think that physicians may be inhibited about asking intimate questions of a family member or friend?

Dr Abbate: If you feel uncomfortable asking questions about sensitive subjects, this is a clue that you should not be treating that patient.

What if something goes wrong when treating a family member or friend?

Dr Abbate: When I was being trained to practice medicine in the US, one of my supervisors told a story of a surgeon whose son had appendicitis and although the surgeon was equally qualified to operate, he asked his partner to do so because he did not want to operate on his own son. Sadly, the child died. My supervisor used this story to illustrate why it is not a good idea to operate on one’s own child. He said, “Think of how overwhelmed with grief and guilt the surgeon would have felt if his child had died during surgery that he himself was performing.” The surgeon would feel grief either way, but perhaps the surgeon felt guilty that he wasn’t the one personally performing the surgery and had instead given the care of his child over to someone else.