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Tuesday May 02, 2017

I'm Invited to a Patient's Wedding; Should I Save the Date?

I attended my first funeral when I was in college. He wasn't a friend or family member. Dwayne was a patient with HIV who I met while volunteering with hospice.

Dwayne was a gifted musician who played by ear and lived for the nights. In our time together, he recounted his days in Los Angeles. Although his death wasn't unexpected, I found myself surprisingly upset when he died. Attending his funeral seemed like the tiniest way to honor his vibrant life.

Like many other patients, Dwayne has had an impact on my life that's difficult to capture in words. Since his death, I have become a family physician with a large population of lesbian, gay, bisexual and transgender patients, including some who live with HIV successfully for decades.

Attending a patient's funeral is not unusual for health care professionals. One Australian study found that 71 percent of primary care physicians have attended a patient's funeral(www.sciencedaily.com). Attendance is often cathartic for doctors. But it also demonstrates respect to the patient's family, a reminder that their family member was loved. It's also easy to be discreet at a funeral, to pay one's respects and depart.

I always anticipated I would be invited to several patients' funerals in my career, whether formally or informally. But I also am receiving invitations from patients that I didn't anticipate, including to weddings, graduations and birthday celebrations.

I'm conflicted on how to respond.

My first wedding invitation from a patient came by email. It was a save-the-date note from a young woman who later convinced her doctor-averse fiancé to become my patient, as well. When I placed the woman's intrauterine device, she joked that she was glad she could safely drink alcohol on her wedding day. An invite came shortly after.

My second invitation came by snail mail to our office, and it was not entirely unexpected. I was privileged to be this patient's doctor when he initially met his future husband. He has shared with me wedding planning details -- meeting with their photographer, finding a caterer able to create a delicate balance of healthy yet scrumptious food for the event, etc.

My third invitation was verbal and came from a patient I had treated for anxiety and depression when she was struggling through the aftermath of a divorce. Her subsequent relationship was with an old friend of hers who always had a presence in her life. Their engagement felt serendipitous.

Piecing together a wedding guest list is daunting. In some cultures, it's not uncommon to invite hundreds of guests from all circles. I suspect professionals in any field have similar dilemmas. I went to a wedding where I met the couple's financial adviser and another where I met their real estate agent. But I don't know if financial advisers and real estate agents face the same ethical quandary that health care professionals do.

Defining the appropriate boundaries between doctors and patients is an ever-changing art. With the emergence of social media, much has been written on "friending" patients online and using caution when communicating virtually.

The rules are open to interpretation. And blanket ethics hardly apply. Physicians in rural areas are often friends with their patients. They attend birthday parties, go golfing together, and run into each other at the grocery store, church and PTA meetings.

A general principle for weddings is to invite only those you expect will come to your 25th anniversary. By that standard, it's no surprise I was invited to my patients' weddings. Given our lifelong relationships in family medicine, I expect I will know many of my patients until one of us dies (or moves).

But accepting an invitation can bring awkwardness. How do I introduce myself to others who ask how I know the couple? How much should I spend on a gift? And will my patients ever look at me the same way if they see me dance?

On the other hand, if I say no -- how do I do it? And why? And do I still send them a gift as I do when I decline friends' invitations?

I spoke to a few colleagues about the subject and received an array of responses. One said she attended a patient's backyard birthday party and saw no issues. Another asked what benefit it would be to the patient for a physician to attend. If there was an obvious benefit, then it made sense to attend. Another was insistent that we should not blur our professional lines with patients by attending social events. Finally, one colleague wondered why this was even an issue. Of course I should attend, he said.

As a family physician, I have powerful, unique partnerships with my patients. They've often shared intimate details of their lives with me that no one else knows -- in some instances, not even their spouses. I imagine all the milestones I will be a part of in their lives: job changes, new hobbies, children, pets, travel, unexpected health diagnoses, hard-fought successes, losses. Attending a wedding could signify yet another milestone we are part of, or it could just complicate our already tangled doctor-patient relationships.

Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan(twitter.com).

Posted at 10:17AM May 02, 2017 by Natasha Bhuyan, M.D.

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