Ethics of Being the Family Doctor of Friends
Being the family doctor of friends is generally not ethical due to potential conflicts of interest, loss of objectivity, and blurring of professional and personal boundaries.
Ethical Considerations
Conventional wisdom and professional ethics generally dictate that physicians should avoid doctoring family members and friends because of potential conflicts of interest 1.
When physicians participate in the care of family members or friends, they risk losing objectivity and confusing their personal and professional roles 1.
The practice raises ethical concerns for the welfare of both the patient and the physician 2.
Common Scenarios and Challenges
Despite ethical concerns, cross-sectional surveys find that providing care to family members and friends is commonplace among physicians 1.
Physicians often receive medical requests from family members and friends that range from simple information requests to requests for medical opinion and judgment 3.
These requests may occur in formal settings like the emergency department or as informal "curbside" consultations 2.
Decision-Making Framework
When confronted with medical requests from friends, physicians typically consider:
- The nature and strength of the relationship with the friend 4
- Their confidence in their own knowledge and skills for the specific situation 4
- Potential consequences of making mistakes 4
- Impact on work-life balance 4
- Risk of disturbing the existing physician-patient relationship the friend may have with another doctor 4
Differences Between Junior and Senior Physicians
Senior physicians tend to apply more nuanced considerations when deciding whether to respond to friends' medical requests 4.
Junior physicians often experience more difficulties dealing with these requests, are less inclined to respond, and are more concerned about interfering with existing physician-patient relationships 4.
Practical Guidance
When approached by friends for medical care, physicians should:
Be clear about the expectations of the requester and themselves - whether it's simple factual information, medical judgment, or more substantial involvement 3.
Treat interactions with friends with the same professional expertise and judgment as with any patient 3.
Be aware that performing a physical examination or charging a fee strengthens the establishment of a legal physician-patient relationship 3.
Respect the friend's autonomy and confidentiality and conform to HIPAA requirements where applicable 3.
Alternative Approaches
Except for convenience, most benefits of getting involved in a friend's care can be realized by acting as a friend or advocate rather than as a physician 1.
Physicians can ask themselves, "What could I do in this situation if I did not have a medical degree?" and consider avoiding acts that require a medical license 1.
Facilitated group discussions where experiences are shared can help physicians, especially junior ones, develop personal strategies regarding provision of medical advice to friends 4.
Cultural Considerations
Different cultures have varying perspectives on the physician-patient relationship and medical decision-making 5.
In some cultures, physicians may be adopted into the family unit and addressed as family members, which can further complicate professional boundaries 5.
Cultural sensitivity is important when navigating these complex relationships, as expectations may differ based on cultural background 5.