At the recent ASCO meeting, one session focused on an issue faced by every clinician -- what to do when a family member or close friend asks you to take care of them. In this exclusive 51˶ video, two presenters at the session -- of Emory University School of Medicine in Atlanta, who has been involved in ethics research for 30 years; and a hematologist from the University of Florida Health in Gainesville -- discuss the issues that can come up when a physician's personal and professional lives intersect.
Following is a transcript of their remarks:
Pentz: If you are tempted to take care of a loved one or a family member, then I would advise you that you not do that. Here's the reason why. It's recommended by the American Medical Association not to do that, but more important, you have a personal relationship with this person, and it'll be very difficult for you to be objective like you would with your regular patients.
What you can do instead is find the best person possible, because you will know the contacts and the links and how to evaluate the best person possible. Then you can keep your role as a loved one and be by the patient's side while you go to this objective, third-person practitioner who you recommended as being a person who would be the perfect person for whatever is going on.
Exceptions
Now, of course, for little things like their prescription has run out and they can't get hold of their doctor, as an ethicist I have no objections to you calling that in, right? Or if there's an emergency and there's no one else available, then obviously you need to step up and take care of this loved one. But in general, our recommendations are, across the board -- and this is a consensus statement -- that you not be their doctor. You be their loved one.
Two Roles
It's a bad idea to take care of a loved one, because it is a loved one. Even though we think we can be objective and just put on our physician hat and do it, we are going to be playing two roles at the same time that are very hard to do. It's much better to stick with the role of a loved one and a companion and be by the patient's side and interact together with the objective doctor.
Your First Impulse
I think it's easy to fall into just taking care of your loved one, because it's easy and you just think to do it, right? I think our first impulse is we'll just take care of it because we're in charge and we can handle things. But sometimes our first impulse is the wrong impulse. I think we're having this talk at the ASCO meeting to remind physicians and other practitioners not to do the first impulse, but to think through about what is best for a loved one.
How to Respond
When your aunt or your cousin calls you up and says, "I have this issue. Can't you take care of it for me?" You can answer, "I can take care of it for you, and the best way to take care of it for you is to find the best physician possible, and I can do that because I have that expertise. Once we find that person, then I can help you sort through all the information that you get from that physician and together we can work on this problem together." That's the best way to respond to this, because then you can be the loved one, the confidante, but you don't have to be the physician making the objective recommendations.
If the loved one persists and says, "Why can't you do it?" then tell them, "It's because I love you and I want to keep it that way, and I want somebody else to be the doctor."
Close: But when you consider who truly are our loved ones, those get to be our close friends, those can be our colleagues, and that's when there's not as clear of an answer, and those need to be taken on a case-by-case basis.
I think some of the best things to consider are whether or not you, as a physician, can remain objective in their care, and I think it's also important to remember that it may be hard for you to care for this person and how it will have an emotional tag. I think that both parties need to consider whether or not the relationship that previously exists can transition to a physician-patient one.
Set Guidelines
Once that decision is made, then I think it's very important that you set guidelines and boundaries of how your relationship has now changed and what roles you have as the patient and have as the physician and decide what will suit each other. But central to that is that you shouldn't rush into it, and you should make sure you consider how to protect both parties so that the patient will receive the optimal care during that relationship.
The Same Care
If I were approached by a close friend or a colleague who asked me to be their physician, I would first have to consider whether or not I could transition to a physician-patient relationship and be able to provide them the same care that I would provide to any patient that came to my clinic. If the answer at the end of the day was no, I could not, that either it would cause me to treat them differently in any way, then I really should consider referring them to somebody else.
Physician Shortage
This is harder in some communities where there may not be a lot of options for providers, but in many communities, there are multiple providers available. In the case where the patient just sits too close to your heart, I think those are good times to transition to a colleague instead.
Your Child's Teacher
We face this everyday. So say I'm a breast oncologist and I have a close relationship with my son's kindergarten teacher and she's diagnosed with cancer. She will likely come to me and ask that I become her provider, and I really, at that time, need to consider how can I set up this relationship? I think most of the time someone [else] would take on that patient. We're not family.