Kenneth Prager, MD, is Professor of Medicine, Director of Medical Ethics, and Chair of the Medical Ethics Committee at Columbia University Medical Center, New York, NY.
Do you think that it is acceptable for physicians to offer medical care to family and friends who are not their patients?
Dr Prager: I don’t see a problem in the case of very simple or relatively minor situations—for example, if a relative or friend calls me or one of my children has a chest cold and needs an antibiotic. But I would not do so in more complex or serious situations.
What about having a relative or friend as a patient?
Dr Prager: It depends on many variables, such as the nature of the relationship and the personalities of the people involved. I was the primary doctor for a number of my friends and it did not seem to be problematic. But in some cases, it can be a little more emotionally taxing, especially if the person has a serious illness. I can see where those emotions could interfere with a more objective assessment of the situation. Serving as a person’s primary internist and being the quarterback is one thing, but in the event of chronic illness, emotions can get involved and the friendship can become a hindrance. For example, if I were an oncologist, I would not want to treat one of my friends for a malignancy. But if I am an internist, conducting an annual checkup for hypertension or diabetes, I don’t see many emotionally demanding or sensitive issues that might interfere.
I do draw a distinction between treating friends – even close friends – and relatives, especially immediate family. Other than something very routine, I think it is not a good idea.
Would you feel inhibited about asking sensitive questions of your patient if he or she were a friend?
Dr Prager: I could see where asking about sexual practices might be problematic in treating a friend, but much depends on the personality of both the doctor and the patient. But I could certainly see bringing up subjects such as weight or alcohol use and even end-of-life care with a patient who is also a friend. In fact, it could even be more effective than if a different physician were raising these issues. A friend might take advice more seriously from me as a good friend than from another physician he or she feels neutral about or dislikes. Obviously this doesn’t mean that people don’t love or trust physicians who aren’t friends, only that sometimes, the word of a good friend can carry extra weight.
Ultimately, I think it is a nuanced issue and the statement of the AMA appropriately can’t be a nuanced declaration. Perhaps it’s not always a good idea to have friends as patients if there are alternatives. But there are exceptions in which a physician whose friend is a patient can offer excellent care, and good, effective communication.
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