The AMA has consistently advised against treating friends and family. A good summary of their rules and the thought process behind their rules can be found on Google. As a family physician, I treated multigenerational families. In a sense, I became part of those families, at first caring for a young couple’s babies, then their toddlers, progressing to the point of caring for the babies of the infant I cared for 25 years prior. In the 34 years I practiced medicine, I cared for families that included great grandparents, grandparents, their sons and daughters and their grandchildren.
Notice the word “caring” in the sentence above. Caring is what it is all about; and, if you genuinely care for your patients, then eventually they become friends or even family by choice. So, do you fire your patient because he/she has melded you into their family? Of course not!
Surely, knowing the entire family history and how injury or disease affects not only the patient but his/her significant others gives the family physician a distinct advantage over other specialists. In turn, the family knowing their physician through multiple interactions gives the family and its individual members the trust they need to respond in dire times and difficulty situations.
Don’t get me wrong. Treating family and friends does pose special problems but a well-trained physician should be able to deal with those instances. A few examples will help you understand my stance on the AMA’s position.
I’ve known family “A” for years. I care for their parents and their children. I bump into the wife (”W”) at Costco and we spend a few minutes catching up on life. I haven’t seen “W” as a patient in 6 months but she has been in multiple times with the children. I note that “W” is not herself. She seems a bit anxious and guarded which is distinctly different from her usual affable demeanor.
Me – “W,” what’s wrong?
W – Nothing.
Me – You don’t seem yourself today. Is everything at home ok?
W – Everything is fine.
Me – I’m glad everything is fine. You know you can talk to me about anything if you need to.
I got a call that afternoon. She thought about it and decided to share what was happening. She did not want any information shared with her husband and I assured her it would not be. She had a sexual problem and felt her gyne was ignoring it. She wanted an internal exam; and, since we were kinda friends/family, she didn’t want to put me in an awkward position. I reassured her and she came in for an exam. Problem solved.
The husband called me that afternoon to pump me for information. He called me “Stu” which was a tipoff that he was going to play the friend/family card. He was upset that I would not divulge any information but quieted when I reminded him that I held my patient’s information to be every bit as sacred as a priest did in the confessional. I knew he was a devote Catholic and that the comparison to a priest’s responsibilities would win the day.
Had I not known her well enough to pick up on the subtle changes associated with her fear of illness, her diagnosis and treatment would have been delayed. Had she not felt comfortable with me in my physician role, she would have gone untreated. One of her concerns was the fact that she needed an internal and how that would affect our friendship/family relationship.
In life, each of us wears many hats. When I put on my doctor’s hat, I go into doctor mode. In doctor’s mode, an internal is no different than a throat swab. The trick is getting the patient to understand that fact. When patients become friends/family, they get to see the transition from Stewart the jokester, foodie, family man to Doc, the caring, serious diagnostician.
Story number two involves a 60 some year-old female in for her pap smear. Her doc had just retired and she was looking for a new doc. I had been taught to talk my way through an internal; and, before doing her rectal exam I asked, “have you ever had a problem with the rectal part of the exam?” Her answer was an emphatic NO and that no one had ever done a rectal on her and no one ever would.
I was blown away! Her lifelong gynecologist was one of my best teachers and Dr. “K” taught his students to do rectal exams on all patients who were in for their annuals. I talked with Dr. “K” a few weeks later and he reassured me that his notes were accurate and rectals had been done but never discussed. The difference was obvious: “K” had a long-term trusted relationship that allowed him to do what he needed to do without informed consent and I didn’t.
What has being retired due to illness taught me about treating family and friends? Story number three:
On the day I was discharged from inpatient PT, a longtime patient (I’ll call him LTP) called asking if there was anything Renee or I needed. My usual request is for a 40-year old red headed nurse and he said he would find one. I was joking; he was not. He called several times over the next week and we finally decided that he would pick me up at rehab (giving Renee an afternoon off) and we would go to lunch. We had a blast. Turns out that he was funny as could be; and, if not for the AMA rules, we would have been lifelong social friends. I have thanked God for LTP on a regular basis.
While I treated friends, I rarely socialized with them. I often ducked dinner invites and other offers including a villa in Greece. I shouldn’t have! My life would have been richer had I socialized with my patients. I should have taken Renee to Greece when I was whole.
My advice to future physicians is to ”care” for and about their patients; and, if that caring relationship leads to friendship, then accept it as long as you can maintain appropriate barriers when needed. As far as treating immediate family, who better to know their history, personalities, strengths, and weaknesses. Make sure they know who to see if they are uncomfortable seeing you and that you have adequate referral sources should you be uncomfortable seeing them.
For those of you who believe that you will not treat family, wait for that 3 am fever and abdominal pain and see how strong your convictions really are! I bet you’ll treat them rather than awaken the doc on call.
Here’s your joke:
A woman playing Golf hit a man nearby. He put his hands together between his legs, fell on the ground & rolled around in pain. She rushed to him & offered to relieve his pain as she was a Doctor.
Reluctantly, he agreed. She gently took his hands away. Unzipped his pants & put her hands inside. She massaged him tenderly for a few minutes & asked: “How does it feel?” He replied: “Feels great but I still think my thumb is broken.”
And my favorite:
I went to the doctor and he said, “Don’t eat anything fatty.”
I asked, ” No bacon? No burgers?!”
To which he replied, “No, Fatty, just don’t eat anything! “