The Limits of Treating Loved Ones

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The Limits of Treating Loved Ones

Physicians who provide medical care for themselves or family risk losing objectivity and letting their personal feelings interfere with what is best for the patient. By Carolyne Krupa, amednews staff. Posted 2.6.12. Reprinted with permission from American Medical News, Copyright 2012, American Medical Association. All rights reserved.

It was a busy day for the cardiologist. Between juggling patients, he received a phone call from his mother. She said she had heartburn and complained that none of the usual over-thecounter medications had helped. So the cardiologist quickly called in a prescription for her for an acid blocker and went back to seeing patients. Late afternoon, his mother called again -- this time from an emergency department. The doctors there said she had a heart attack.

It’s a story that Humayun Chaudhry, DO, president of the Federation of State Medical Boards, told medical students during his teaching days. The cardiologist, a former colleague of Dr. Chaudhry’s who was well-respected in the field, couldn’t believe he had missed the diagnosis in his own mother. “There was a disconnect because it was his mother calling,” Dr. Chaudhry said. “That objectivity was just never there.” Professional ethics policies have long warned about the perils of physicians treating themselves or family members. Many state medical boards have rules restricting the practice, particularly as it relates to prescribed controlled substances. Medicare and private health insurers often refuse to pay for the care.

Such rules warn that physicians who treat themselves or relatives risk providing inferior care that could harm those you love. Yet medical board officials say such rules are commonly violated by well-meaning physicians either knowingly or unknowingly.

A 2011 survey of more than 1,000 physicians in North Carolina found that nearly half had treated themselves and that 85% had treated an immediate family member, significant other or close friend. “We’ve dealt with this extensively for years,” said Scott Kirby, MD, medical director of the North Carolina Medical Board. “It is frequently an issue that comes to the attention of the board, because physicians provide care to family members or to themselves that is generally below standards. They cut corners. They don’t do things they would normally do in treating a patient.”

“A fool for a patient”

Doctors often have a blind spot about treating themselves or relatives, said Glen Stream, MD, president of the American Academy of Family Physicians. “We as physicians could unknowingly set ourselves up to compromise the care of those most close to us.” he said. Dr. William Osler, a physician and professor who helped found Johns Hopkins Hospital in 1889, put it more bluntly: “ a physician who treats himself has a fool for a patient.”

Whether physicians are treating themselves or relatives, many of the dangers cited are the same. They center around risks of loss of objectivity. “It really is a matter of patient protection,” Dr. Kirby said. “The patient is receiving substandard care.” Physicians often jump to conclusions or make assumptions about themselves or loved ones that they wouldn’t with a typical patient. They are less likely to take a thorough medical history or keep any records, said Lois Snyder, director of the American College of Physician’s Center for Ethics and Professionalism. The ACP’s recently revised ethics policy states that physicians shouldn’t treat themselves, except in emergencies when other no other options are available. “A physician cannot adequately interview, examine or counsel herself; without which, ordering diagnostic tests, medications or other treatments is ill-advised,” the policy says.

American Medical Association policy issued in 1993 warns that one’s personal feelings can interfere with sound medical judgment. Physicians treating themselves or loved ones may be inclined to treat problems that are beyond their expertise or training.

Informed consent also is a concern in treating family members, because a spouse, child, sibling or parent may be reluctant to refuse care from a relative, AMA policy says. Doctors may fail to ask sensitive questions or perform intimate parts of a physical exam, or a patient may feel uncomfortable giving sensitive information to a relative. “In particular, minor children will generally not feel free to refuse care from their parents,” the AMA policy states,. “Likewise, physicians may feel obligated to provide care to immediate family members even if they feel uncomfortable providing care.”

It is inappropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members, except in emergencies, AMA policy says.