From the Guidelines
Physicians in the United States should avoid treating their family members whenever possible, except in emergency situations or underserved areas where alternative care is not available, due to concerns about objectivity and professional judgment. This recommendation is based on the American Medical Association's guidelines and the potential for boundary violations, as discussed in the study on professionalism in pediatrics 1.
Key Considerations
- Treating family members can lead to a loss of objectivity and failure to explore sensitive issues, which can compromise the quality of care provided.
- The American Medical Association advises against treating immediate family members due to concerns about objectivity, professional judgment, and potential complications in the doctor-patient relationship, as noted in the study 1.
- Emotional attachment can cloud clinical judgment, leading to potential complications and decreased quality of care.
- Exceptions to this rule include emergency situations or underserved areas where alternative care is not available, as mentioned in the study 1.
Clinical Implications
- For minor issues like prescribing antibiotics for strep throat or providing routine vaccinations, family treatment may be acceptable.
- However, for complex conditions, chronic disease management, mental health issues, or situations requiring invasive procedures, physicians should refer family members to other healthcare providers to ensure objective and unbiased care.
- Physicians should prioritize maintaining appropriate boundaries and avoiding potential conflicts of interest when treating family members, as discussed in the study 1.
From the Research
Treatment of Family Members by US Physicians
- US physicians often treat their family members, with 99% of respondents in a 1991 study 2 reporting requests from family members for medical advice, diagnosis, or treatment.
- The same study found that 83% of physicians had prescribed medication for a family member, 80% had diagnosed medical illnesses, and 72% had performed physical examinations.
- However, some studies suggest that treating family members can be problematic, with 33% of physicians in the 1991 study 2 reporting that they had observed another physician "inappropriately involved" in a family member's care.
- A 2019 study 3 notes that there is limited evidence available on the ethics of treating family members, but examines various ethical principles that can guide decision-making in this area.
Ethical Considerations
- A 2012 study 4 presents cases where patient family members who are physicians can complicate medical care, highlighting the need for clinician-relatives to allow the medical team to assume the role of caretaker.
- The study suggests that teams may need to employ limit-setting to ensure fair and consistent care for all patients and prevent emotionally charged situations.
- A 1994 study 5 found that physicians report treating their own family members rarely and face significant dilemmas when doing so, with older, male, and rural physicians providing more services to family members than their younger, female, and urban counterparts.
Physician Obligations
- A 1994 study 6 explores the relevance of family interests in treatment decisions and the resultant ramifications for physicians' obligations to patients.
- The study addresses questions about what a physician should do when patient autonomy threatens to negate the patient's moral obligations to other family members, and whether respect for patient autonomy requires efforts to keep patients' treatment decisions from being influenced by family considerations.