There are inherent problems when treating anyone with whom you have a close personal relationship. The new Code issued by the Medical Board of Australia states:
4.15 Providing care to those close to you
Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the patient and doctor. In particular, medical practitioners must not prescribe Schedule 8, psychotropic medication and/or drugs of dependence, or perform elective surgery (such as cosmetic surgery) to anyone with whom they have a close relationship. In some cases, providing care to those close to you is unavoidable, for example, in an emergency. Whenever this is the case, good medical practice requires recognition and careful management of these issues.
The Medical Board has always given very close scrutiny to doctors who have treated family and friends.
The Legal Services team have assisted members and clients with investigations by the Board into treatments including:
- Cosmetic surgery performed on a family member
- General anaesthetic performed on a doctor’s child
- Wound management on a spouse.
The next time you are approached by someone with whom you have a close relationship with a request for advice or treatment, remind yourself of the following consequences:
Lack of objectivity
Your ability to be independent is affected given the relationship between you and a relative, friend or someone you work with. The emotional connection affects professional objectivity and potentially assessment and treatment.
Due to the extra familiarity, you may be less formal and may be more likely to take short cuts at various stages, such as not taking a thorough history or adequately assessing the patient’s condition. You may fail to document and keep medical records. You may have “inconvenient” background information that risks you being mislead if you follow your patient’s instructions. In addition, some subjects or forms of examination might be too embarrassing to broach and the patient may feel unable to discuss “warts and all”. You may have the “consultation” outside of your clinic environment.
Acting outside of your area of expertise
There may be an expectation by relatives, friends and close friends that as a doctor you are able to handle any medical problem that arises, even if the matter is outside of your usual area of expertise. There can be the temptation to do things you would normally refer on.
Confidentiality and privacy
There may be a risk that your obligation to maintain the patient’s confidentiality/privacy is overlooked. Your “patient” may be wary in any event that you will disclose their condition/treatment to other relatives or friends.
Unmanageable patient expectations
Relatives, friends or those with whom you have a close personal relationship may make unreasonable demands and expect you to perform miracles. They may not want to accept what they are being told. When things go wrong, there is potential to damage the personal relationship. In addition, the patient could be inhibited from seeking redress.
Treatment of those with whom you have a close relationship is generally only acceptable in an emergency or necessity type situation. Where no help is available or other care is not accessible, you can treat people with whom you have a close relationship until another practitioner is available or another solution found.
Providing care and treatment for someone with whom you have a close personal relationship is only one step removed from treating oneself. It is hard to be independent and objective when advising and treating your close friend or family member, especially a child, parent, grandparent or sibling. It is better that you be a personal support to them and an advocate for their care.
If ever in doubt about boundary issues please give our Legal Services team a call. We are here to help.