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When should you say no?

Fam Pract Manag. 2017;24(4):44

Author disclosure: no relevant financial affiliations disclosed.

Family physicians have the awesome responsibility of providing comprehensive medical care to each member of the family regardless of age, sex, or type of health problem. But does this responsibility include providing health care to your own family and friends?

Many of us have been asked at one time or another by a relative, coworker, or friend for medical advice or treatment, but often we are uncertain about how to handle this type of request. It can be a difficult situation when your sibling asks you to take care of his health condition or a friend asks you to prescribe medication over the weekend when she is unable to reach her physician. Although you may sincerely want to care for them, is it ethical to do so?

Recently, I faced a situation where I had to care for a friend's daughter who was unable to obtain health care because she was uninsured. Although I was able to help her get health care assistance through the state health department, the medical offices that accepted her assistance program were not accepting new patients at the time. She had a health condition that warranted immediate attention, so I decided to see her in my clinic.

A few months later, this patient died due to complications related to her health problem, and I had to inform her parent, who is also my friend. It was difficult not to be emotional with this family, and it made me question whether I should care for friends or family in the future.

Ethics statements by the American Medical Association, the American College of Physicians, and others warn that the patient-physician relationship can be complicated by pre-existing social and emotional relationships.1,2,3 They recommend that physicians first consider alternative sources of care or referrals to other providers and take care of friends of relatives only if there are no other options. Additionally, physicians should treat patients with whom they have a prior nonprofessional relationship only if they have a short-term, minor problem or an emergent medical condition. In these cases, it is important to set expectations with relatives or friends and make every effort to treat them with the same professional judgment you would use for other patients.

Physicians should also be aware of the pros and cons of caring for friends and family. The physician-friend or physician-relative relationship might benefit patients, for example, by giving them easy access to their physician who may devote extra attention to their health concern.3 It may also be personally rewarding to the physician to help a friend or family member. On the other hand, the familiar relationship may come with risks, such as failure to take an adequate history, perform a thorough physical examination, provide counseling on sensitive issues, or keep appropriate medical records.3

The physician-friend or physician-relative relationship is complex. State medical boards or insurance plans may have guidelines governing these relationships. But where there are no concrete rules, physicians must decide for themselves on appropriate boundaries. The key issue is whether you can maintain sound professional judgment, confidentiality, and objectivity. If not, it may be best for you, your loved one, and your relationship if you gently steer the person to another source of care.

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The opinions expressed here do not necessarily represent those of FPM or our publisher, the American Academy of Family Physicians. We encourage you to share your views. Send comments to fpmedit@aafp.org, or add your comments below.

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