It’s hard to say no to family and friends when they ask for help. For doctors, it poses a real ethical and legal dilemma if a family member or friend asks for medical advice or treatment.
Accomplished plastic surgeon’s sister discovers a melanoma
Dr A* is a plastic surgeon working in an inner-city practice. She is asked by her sister, Susie, to remove a melanoma from her stomach and says to her sister that she doesn’t have a problem doing this for her and would like to help out. However Susie’s GP advises her when she visits for a referral that it’s not appropriate for her sister to operate on her as this would contravene the code of conduct. Dr A admits to being surprised to hear this and phones Avant for advice.
As for the treatment of friends and family, Good Medical Practice: A Code of Conduct for Doctors in Australia (the Code) says:
‘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 doctor and patient.’
But, what if… ?
In what scenarios would it be appropriate for Dr A to treat her sister? Emergency situations, for example, where not treating Susie would put her life at risk or the outcome is considerably less favourable, are provided for in the Code:
‘In some cases, providing care to those close to you is unavoidable. Whenever this is the case, good medical practice requires recognition and careful management of these issues.’
Take the case of the Roberts family who live on a farm in rural South Australia. Joe Roberts is carving the turkey on Christmas Day when he slices his hand with the large carving knife. Fortunately Joe’s brother, Michael, who is visiting from Adelaide happens to be a plastic surgeon and an expert hand surgeon. They ring the local hospital and Joe’s GP and admitting rights are urgently arranged so that Michael can operate on his brother at the local hospital to repair the severed tendon.
In this case, careful management of the issue includes making contemporaneous notes about the decision making Michael went through including evidence of having explored and considered any possible alternatives to treating his family member. Post-operative care should also be referred to another available local specialist and Michael should ensure Joe’s GP is informed of the care and treatment he receives.
Ask yourself, ‘How would I be judged by my colleagues?’
Like many situations in medicine, there is no universally clear answer. Ultimately, each case is unique and should be assessed on its own merits. Part of this assessment requires consideration of your ethical and legal obligations. Reflection on the following key issues will help:
- How would you be judged by your colleagues?
- Would you be entering into and encouraging a long term doctor-patient relationship?
- Would you be interfering with an existing doctor-patient relationship?
- Would a reasonable standard of care dictate that you take a full history, perform an examination, and order any tests or investigations for this ailment?
- Can you really make an objective clinical judgment or are you too close to them?
If a family member or friend asks you to perform an operation, or treat them in some way, the following advice should help you make the appropriate decision for your circumstances.
- Unless the risk of harm of not treating the person outweighs the risk of harm of any treatment , you should avoid doing so.
- Prepare a respectful and empathetic explanation as to why you can’t perform the procedure. It might be, ‘I would like to help you and the best way I can do that is to help you get an appointment to see another plastic surgeon,’.
- Avoid entering a continuing doctor-patient relationship with a family member or friend. This also applies to anyone you have a business or working relationship with.
In the end, Dr A referred Susie to a colleague
Considering Susie lived in a metropolitan area with access to multiple alternatives, we advised Dr A to arrange for one of her colleagues to perform the operation.
For more on treating family and friends you can read the related article, Doctor disciplined for inappropriately treating family members.
*All names in this case study have been changed and any relation to actual people is purely coincidental.
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