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Ideas and Opinions |

What Do You Do When Your Loved One Is Ill? The Line between Physician and Family Member

Erik K. Fromme, MD; Neil J. Farber, MD; Stewart F. Babbott, MD; Mary E. Pickett, MD; and Brent W. Beasley, MD
[+] Article and Author Information

Acknowledgment: The authors thank their family members and the 2 anonymous reviewers whose comments were so helpful in improving this manuscript.

Grant Support: Dr. Fromme is supported by a Career Development Award from the National Cancer Institute (K07CA109511-01A1).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Erik K. Fromme, MD, Oregon Health & Science University, L586, Division of Hematology and Medical Oncology, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239; e-mail, frommee@ohsu.edu.

Current Author Addresses: Dr. Fromme: Oregon Health & Science University, L586, Division of Hematology and Medical Oncology, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239.

Dr. Farber: University of California, San Diego, 8939 Villa La Jolla Drive, Suite 110, La Jolla, CA 92037.

Dr. Babbott: University of Kansas Division of General and Geriatric Medicine, 5026 Wescoe Pavilion, Mail Stop 1020, 3901 Rainbow Boulevard, Kansas City, KS 66160.

Dr. Pickett: Oregon Health & Science University, L-475, Division of General Internal Medicine, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239.

Dr. Beasley: University of Missouri-Kansas City, Saint Luke's Hospital, Department of Medical Education, 4401 Wornall Road, Kansas City, MO 64111.


Ann Intern Med. 2008;149(11):825-829. doi:10.7326/0003-4819-149-11-200812020-00011
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Conventional wisdom and professional ethics generally dictate that physicians should avoid doctoring family members because of potential conflicts of interest. Nevertheless, cross-sectional surveys find that the practice is commonplace.Physicians have unique opportunities to influence their family member's care because they possess knowledge and status within the health care system; however, when physicians participate in the care of family members, they must not lose objectivity and confuse their personal and professional roles.Because health care systems are complicated, medical information is difficult to understand, and medical errors are common, it can be a great relief for families to have someone “on the inside” who is accessible and trustworthy. Yet, the benefits of becoming involved in a loved one's care are accompanied by risks, especially when a physician takes action that a nonphysician would be incapable of performing. Except for convenience, most if not all of the benefits of getting involved can be realized by physician–family members acting as a family member or an advocate rather than as a physician.Rules about what is or what is not appropriate for physician–family members are important but insufficient to guide physicians in every circumstance. Physician–family members 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.

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Self and Family doctoring
Posted on December 2, 2008
Ahmad Kaako
UTCOM Internal Medicine Resident
Conflict of Interest: None Declared

This is a very good article that touches on sensitive issues that we all, as physicians, face over and over in our professional life.

What Do You Do When You Are Ill? Self-doctoring is another issue that has some benefits with significant risk. There might be an observation that health care providers, including physicians and nurses, when they got ill, are probably on higher risk for complication secondary to the delay in workup and diagnosis. 52-90% of physicians reported self prescribing medications started even in the medical school. Thomas Percival, an English Physician, wrote the first code conduct regarding physicians caring for their selves and their families in his book, Medical Ethics.

In one study, 23 physician-patients previously treated for cancer were interviewed. Health care-seeking strategies fell on a continuum that ranged from a purely patient role to one that centered on physician activities. Participants identified problems associated with overdependence on either role, suggesting that a balanced approach, one that uses the advantages of both physician and patient roles, has merit.

Refrences:

Doctors Who Doctor Self, Family, and colleagues Krall EJ. WMJ. 2008 Sep;107(6):279-84.

Self-doctoring: a qualitative study of physicians with cancer J Fam Pract. 2004 Apr;53(4):299-306.

Conflict of Interest:

None declared

Protecting family members from errors
Posted on December 9, 2008
Victor S. Sloan
No Affiliation
Conflict of Interest: None Declared

To the Editor:

The authors provide a wonderful overview of the risks in crossing the line from caring family member to provider. However, asking "what could I do in this situation if I did not have a medical license" begs the question raised by the authors themselves in the vignette "Grateful involvement." Dr. Y noted substandard care being provided to his child and (appropriately) insisted on the correct care being delivered. There are numerous reports of the high rate of medical errors in our health care system (1, 2). As physicians, we are in a unique position to note and attempt to correct these errors. Without a license (or at least medical training), we would probably not recognize those errors. Certainly, we have a goal of reducing errors across the board, but as Dr. Y notes, "...care for our son came first...My family trumped all." We would be less than human if we believed otherwise.

References

1. Schoen C, Osborn R, Huynh PT et al. Taking the pulse of health care systems: Experiences of patients with health problems in six countries. Health Affairs. DOI 10.1377/hlthaff.W5.509, 2005. Accessed December 8, 2008.

2. Agency for Health Care Research and Quality. www.ahrq.gov/qual/errback.html. Accessed December 8, 2008

Conflict of Interest:

None declared

the corollary is self prescription to overcome physician inertia
Posted on December 12, 2008
oscar,m jolobe
manchester medical society, co john rylands university library, oxford road manchester
Conflict of Interest: None Declared

There is a mistaken belief that the justification for suspending one's own clinical judgement in favor of the clinical judgment of the physician who looks after you or your family is that "he (or she) knows best". Nothing could be further from the truth when it comes to the management of hypertension. In this context there is an institutionalized inertia towards uptitrating the dose of antihypertensive medication to the goal blood pressure(BP) of optimum blood pressure, namele < 120/80 mm Hg. I know this from personal experience, having been diagnosed with hypertension(BP 170/90 mm Hg) at the age of 55 following identification of hypertensive retinopathy by an optometrist during a routine eye test.

Let us abandon the myth that one's own primary care physician always knows best. When it comes to antihypertensive treatment, the primary care physician is just as liable as all his peers to the institutionalized inertia which prevents acheivement of optimum BP. In fact few primary care physicians would beleive that a 70 year old like myself can have his antihypertensive medication titrated to optimum BP, not only without side effects, but also with the "bonus" of expriencing an improvewment in renal function.

Conflict of Interest:

None declared

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