This e-learning module will help physicians identify and understand how to maintain boundaries with their patients as well as boundaries for treating family, self and colleagues.
Code of Medical Ethics Opinion 1.2.1
Treating oneself or a member of one’s own family poses several challenges for physicians, including concerns about professional objectivity, patient autonomy, and informed consent.
When the patient is an immediate family member, the physician’s personal feelings may unduly influence his or her professional medical judgment. Or the physician may fail to probe sensitive areas when taking the medical history or to perform intimate parts of the physical examination. Physicians may feel obligated to provide care for family members despite feeling uncomfortable doing so. They may also be inclined to treat problems that are beyond their expertise or training.
Similarly, patients may feel uncomfortable receiving care from a family member. A patient may be reluctant to disclose sensitive information or undergo an intimate examination when the physician is an immediate family member. This discomfort may particularly be the case when the patient is a minor child, who may not feel free to refuse care from a parent.
In general, physicians should not treat themselves or members of their own families. However, it may be acceptable to do so in limited circumstances:
(a) In emergency settings or isolated settings where there is no other qualified physician available. In such situations, physicians should not hesitate to treat themselves or family members until another physician becomes available.
(b) For short-term, minor problems.
When treating self or family members, physicians have a further responsibility to:
(c) Document treatment or care provided and convey relevant information to the patient’s primary care physician.
(d) Recognize that if tensions develop in the 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.
(e) Avoid providing sensitive or intimate care especially for a minor patient who is uncomfortable being treated by a family member.
(f) Recognize that family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician.
AMA Principles of Medical Ethics: I, II, IV