Health Law Matters

PHYSICIANS:  AVOID TREATING FAMILY MEMBERS!

By  Edward E. Hollowell, JD, FCLM and Kenneth A. De Ville, JD, PhD

Most physicians enter the medical profession because it provides them with the training and opportunity to help people in need. It seems natural therefore, that physicians might be tempted to take a professional role in providing medical care to those persons dearest and closest to them\their own families. Indeed, studies suggest that many physicians regularly provide medical care for their family members. The instinct to take a professional role in providing medical care to a loved one, however, should be weighed against the overwhelming evidence from professional organizations, academic literature and regulatory bodies that uniformly declares the treatment of family members to be professionally unwise and ethically problematical.

The North Carolina Medical Board (Board) issues Position Statements on professional and practice issues to provide guidance for physicians. While the Board's Position Statements are not legally binding, they provide clearly articulated and useful advice and reflect the Board's general view of what constitutes acceptable professional behavior.

The Board's statement on "Self-Treatment and Treatment of Family Members and Others with Whom Significant Emotional Relationships Exist," clearly states that:

... except for minor illnesses and emergencies, physicians should not treat, medically or surgically, or prescribe for themselves, their family members, or others with whom they have significant emotional relationships. The Board strongly believes that such treatment and prescribing is inappropriate and may result in less than optimal care being provided.

The admonition against treating close family members is longstanding and nearly ubiquitous. It is contained in the AMA's first Code of Ethics, adopted in 1847. The current AMA Council on Ethical and Judicial Affairs (Opinion 8.19) and the American College of Physicians' "Ethics Manual," echo the Board's warning against physicians treating family members.

Ethical and professional objections to a physician treating his or her family members are based on the danger that the physician's personal sentiments for his or her patient/family member will undermine rather than enhance the care that their family members receive. Personal feelings and fears might compromise a physician's professional objectivity and judgment leading him or her to either over- or under-estimate the seriousness of the patient's condition. For example, fearing the worst, the physician may over-diagnose a condition subjecting their patient/family members to series of unnecessary tests, treatments, fears and risks. Conversely, physicians, reluctant to face the possibility of a seriously ill family member may dismiss prematurely a viable, but more serious potential diagnosis. These tendencies may be aggravated in that the potential informality associated with treating family members sometimes leads to less scrupulous adherence to traditional protocols of history-taking, physical and diagnostic work-up, as well as record-keeping. Moreover, family members are frequently examined outside the traditional office setting without the appropriate support and proper equipment and resources.

Personal connections may also complicate the way in which the patient/family members and physician interact. Physicians with familial connections to their patients might be less likely to ask potentially sensitive, but clinically relevant, questions or to perform intimate but necessary examinations. Similarly, patient/family members may be less likely to disclose personal facts. Frequently, the very advantage of speaking to an unrelated physician is that information will be kept from family members. The personal distance may enhance disclosure. On one hand, some patients, especially children, may be less likely to refuse and question treatment recommended by a family member who is a physician. On the other hand, older family members may doubt the insight and wisdom of a younger, albeit professionally-trained, physician/family-member and as a result be less compliant. Treating physicians must sometimes play the role of mediator, negotiating between and among family members to help them understand and resolve difficult clinical and emotional questions. Here, too, familial connections can be a handicap rather than a benefit. Familiarity and interlocking loyalties can confound the already challenging issues of confidentially, decision making capacity, informed consent and the host of issues surrounding end-of-life care.

While the Board's Position Statement clearly discourages physicians from treating their family members, providing such care may be appropriate in some limited circumstances. In emergencies, minor illnesses, and in isolated settings in which no other appropriate medical care is available, physicians may legitimately treat a family member. In those cases in which a physician must provide emergency care for a family member, the patient/family-member's care should be transferred to another physician as soon as it is practical. The Board reminds physicians who treat family members for emergency or minor illness that they "must prepare and keep a proper written record of that treatment, including but not limited to prescriptions written for controlled substances and the medical indications for them."

Abiding by the long-standing warning against providing medical care to family members does not mean abandoning loved ones in their time of need. Instead, physicians can best help family members by referring them to them qualified and appropriate health care professionals.

Top Home Areas Attorneys Articles Links Contact Us Disclaimer

Copyright © 2006 -  Mitchell Warner, P.A.        The Medical Law Alert is a publication of the Mitchell Warner Health Law Group. Its purpose is to provide general information about significant legal developments, and should not be construed as legal advice on specific factual scenarios. For more information on the issues discussed in this publication, please contact Edward E. Hollowell, JD, FCLM or Kenneth A. De Ville, JD, PhD, Co-Editors at (800) 662-7403.