Ethics

Family picnic or walk-in clinic? What to do when family asks for care

Being asked to provide medical advice to a loved one is a nearly universal experience for physicians, but most doctors know from medical school that it is unprofessional and even unethical to diagnose or treat a family member. A physician expert provides background on the ethical issues at play in such a situation and suggests ways to respond that help ensure relatives get the care they need without harming interpersonal relationships.

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 understand the limited circumstances under which it is acceptable to treat themselves or members of their families.

Following are highlights from an article in AMA Journal of Ethics® (@JournalofEthics) by Erik K. Fromme, MD, a palliative care physician and associate professor at Oregon Health & Science University. His insights are a commentary in response to a hypothetical case of a physician approached by her uncle for help with a persistent illness.

Why treating family members is problem

There may be laws against it. “There are no federal laws specifically prohibiting a physician from practicing medicine, writing prescriptions or even performing surgery on a family member,” the author wrote. However, in some states it is illegal or a violation of state medical board code to write a prescription for a controlled substance or a psychiatric medication to themselves or family members, except in emergencies.

Medical protocols need to be followed. In particular, a physician is required to follow the same protocols for all patients, including performing a physical exam and documenting the encounter. “A quick once-over at a family gathering,” Dr. Fromme noted, “may not meet this standard and therefore could be subject to disciplinary action by a medical board.”

Professional objectivity may be compromised. Objectivity is still an issue in cases of emergency, but in these circumstances a physician may be compelled to treat a family member to prevent or minimize harm.

How to deal with it

Listen to your gut. “There is a line (or boundary, if you like) between personal and professional roles, and true professionals feel a twinge of conscience when they think they are crossing it,” according to Dr. Fromme. “This twinge is an ‘early warning sign’ that suggests you are entering potentially treacherous terrain.”

Show concern. Once you feel that twinge, the author advises, show concern by asking questions. You could initially ask, “It sounds like you’ve been feeling pretty ill. Can you tell me more?” You might then follow up with, “It sounds like your symptoms are not going away and are bothering you—I think they’re definitely worth getting checked out.”

Find other ways to help. The author says that, in most cases, you can be helpful without having to use your medical knowledge to diagnose or treat. “Instead, act as a knowledgeable guide and facilitator to help them get the right care from someone else,” he wrote. This could involve helping to expedite an appointment or accompanying the relative to his or her doctor visit.

More help here

The AMA Ed Hub™ offers an online CME course, “Boundaries for Physicians: The Code of Medical Ethics,” to help physicians identify and understand how to maintain boundaries with their patients and boundaries for treating family, self and colleagues. AMA PRA Category 1 Credit™ is available.

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