Should You Care for Yourself, Family or Friends?

It boils downwards to a personal decision in most situations.

Fam Pract Manag. 2005 Mar;12(3):41-44.

This content conforms to AAFP CME criteria. See FPM CME Quiz.

Commodity Sections

  • Introduction
  • Out-of-part experiences
  • Guides for the gray areas
  • What would you practise?
  • Comfort and clarity
  • References

Imagine yourself in this scenario: Y'all've been experiencing a fever, a cough and shortness of breath for a week, and you recall you might take pneumonia. What are you near probable to practice:

  • Self-prescribe antibiotics;

  • Order a chest X-ray on yourself;

  • Curbside a colleague to listen to your lungs and care for you if needed;

  • See your regular physician.

How do you decide when treatment of yourself, family and friends is appropriate? Do you accept a fix of guidelines to brand these decisions? If so, are you lot comfortable with them? Our intent is to aid you reflect on this upshot past increasing your awareness of other physicians' practices and past increasing your knowledge of ethical and legal guidelines for prescribing for yourself, relatives, friends and colleagues. Nosotros hope this adds clarity and condolement to your controlling process.

KEY POINTS

  • Treatment of family unit, friends and self is widespread among physicians, with antibiotics, antihistamines and contraceptives amongst the most commonly involved medications.

  • Once a physician has treated a family unit fellow member or a friend, it may be more difficult to deny care to that person in time to come situations.

  • Upstanding and legal guidelines provide some guidance but leave a lot of area open up for doc interpretation.

  • Other factors that might bear upon a physician'south decision include the need for an exam, the severity of the status, the requested handling and the convenience.

Out-of-part experiences

  • Abstruse
  • Out-of-role experiences
  • Guides for the gray areas
  • What would you do?
  • Comfort and clarity
  • References

To go yourself thinking more virtually this topic, imagine what you would exercise in each of the following clinical scenarios and why:

  • You are on a beach vacation with your family. A relative begins complaining about a toothache, and you doubtable he has a tooth abscess. He would like you lot to prescribe antibiotics. How likely are y'all to do that?

  • Your 8-month-quondam babe has had three days of fussiness and fever up to 102 degrees. You think she has an ear infection. How likely are y'all to expect in her ears and treat her if needed?

  • You are visiting a colleague who is 2 weeks postpartum at home. She is breastfeeding and thinks she has a yeast infection. How likely are you lot to treat her and her baby?

  • A family fellow member calls from out of state, where she is visiting family. She has a cough and requests a narcotic cough syrup. How likely are you to telephone call this in for her?

  • Your neighbor does non have health insurance and thinks he has the flu. After a history and an exam, y'all hold with this diagnosis and think he is dehydrated. How likely are y'all to give him intravenous fluids at home?

  • Yous are at a dinner party, and an associate corners y'all to ask your communication about some migraines she's been having. How likely are you to offer your medical opinion?

Handling of self and non-patients (divers equally people treated outside a standard part relationship, usually without documentation) is common practice. Self-treatment has been reported with percentages ranging from 52 pct to 84 percent of physicians.one–5 Treatment of non-patients is even more widespread, with some studies reporting most 100 percent of physicians engaging in this practice.5–7 The medications nigh ordinarily used in these situations are antibiotics, antihistamines and contraceptives.

Guides for the gray areas

  • Abstract
  • Out-of-office experiences
  • Guides for the grayness areas
  • What would yous practice?
  • Comfort and clarity
  • References

About physicians are not enlightened that ethical guidelines on the treatment of not-patients do exist.1 Section East-8.19 of the AMA Code of Medical Ethics (available online at http://www.ama-assn.org/ama/pub/category/8510.html) states that "physicians generally should not care for themselves or members of their firsthand families" because their professional objectivity may exist compromised in those situations. Exceptions are allowed for "short-term, small-scale issues" or "in emergency or isolated settings." The American College of Physicians (ACP) Ethics Manual (bachelor online at http://www.acponline.org/ethics/ethicman.htm) similarly asserts that "physicians should avoid treating themselves, close friends or members of their own families." Information technology goes on to comment that "physicians should be very cautious about assuming the care of closely associated employees."

Some state medical boards take these positions a pace further. North Carolina requires that the "physician must gear up and go along a proper written tape of that handling," and the Medical Code of Virginia specifies that "records should be maintained of all written prescriptions or administration of whatever drugs."

In addition, some insurance providers, including Medicare and Blue Cross Blueish Shield, ban payments for the care that physicians provide for immediate family members, even in an function setting.

Legal considerations and laws should as well exist taken into account when deciding whether to treat not-patients or yourself. In one case a physician begins treatment, a patient-physician human relationship is established. From that point on, the doctor is liable for the interaction and its consequences. The telescopic of federal police for written prescriptions is limited to controlled substances. Information technology states that a prescriber must have a bona fide patient-physician relationship, including a written tape of information technology. At a minimum, land police force follows federal statutes. However, some states (Massachusetts, for example) further require documenting a medical history and a concrete exam earlier prescribing whatever medication.

The bottom line for ethical and legal guidelines: Don't treat not-patients except in cases of modest issues or emergencies. Document what you do. Stay away from prescribing controlled substances.

Of form, this leaves a lot of area open for physician interpretation of each state of affairs. In improver to the ethical and legal issues above, other factors that might bear upon your decision to care for yourself or non-patients are:

  • The type of relationship and emotional closeness you have with the person beingness treated;

  • Your areas of expertise or grooming;

  • The need for an intimate history or examination;

  • The severity of the condition or diagnosis;

  • The medication or treatment requested;

  • Convenience.

What would you do?

  • Abstruse
  • Out-of-office experiences
  • Guides for the grayness areas
  • What would yous do?
  • Comfort and clarity
  • References

Let'southward get back to the clinical scenarios listed above. Are your answers nonetheless the same? The case involving narcotics should be articulate-cut, but the rest autumn into a gray area. In these situations, every medico might translate minor issues and emergencies differently. Here's how one of the authors, who encountered each scenario, handled them:

You doubtable you have pneumonia. The author's regular doctor was not available. She felt that she could not be objective when dealing with her own care, and she saw a colleague in the function setting. The visit was documented.

Your vacationing relative has a toothache. The author felt that the tooth abscess was a small trouble and decided it was convenient to give her family member an antibiotic when away from home in a somewhat isolated setting.

Your baby might take an ear infection. Though some physicians might experience comfortable treating their kid, the author did not treat her eight-month-old. She felt that the emotional closeness of the mother-child relationship might compromise her medical judgment. If this scenario occurred at night or on the weekend, then some physicians might be more willing to treat their children given the convenience consequence, though it is important to consider setting boundaries.

In addition, consider whether there are certain family unit members you would never care for, or others you would treat under particular circumstances. The issue of precedent within the family should be given real thought. If a dr. sets up the expectation that family unit members volition be treated, it may exist more difficult to deny care. Physicians may want to bluntly discuss with their family the circumstances under which they might consider treating them – or simply say that they volition never treat family unit members.

Your colleague thinks she has a yeast infection. This conclusion could vary depending on a physician's gender and relationship with the colleague. The author did care for her colleague and the baby because she felt that it was a minor, easily treated problem. However, considering treatment might involve examining the breasts, other physicians might accept been uncomfortable and declined handling.

Your family fellow member wants a narcotic coughing syrup. No gray area here. As mentioned to a higher place, this would violate the law.

Your neighbor thinks he has the flu. Hither'due south another situation in which a doctor'due south circumstances could shape the decision. The bilious neighbor presented the writer with a more complicated, higher risk state of affairs. She opted non to treat him at domicile. However, another medico did treat this non-patient outside the office, and the non-patient improved and was beholden. The factors that prompted the 2d physician to do this were the financial state of affairs of the patient and convenience for the patient not having to expect for hours in an emergency room.

An acquaintance seeks medical advice in a social setting. It is a common and sometimes troublesome situation for a medico to be asked for medical communication past a not-patient (or even a patient, for that thing) in a social state of affairs. Rarely does a dr. take plenty information about the state of affairs to provide specific advice. 1 might choose to give general data about the medical condition then refer the patient to his or her own doctor for more thorough advice. A physician could frame that conversation by saying, "Here are some things yous might want to talk nearly with your physician …." Or the doctor could opt not to give any information, citing ethical or legal reasons why it would be unwise.

In all of the higher up situations where care is provided, the medico should document what took place, fifty-fifty if the handling was minor.

Condolement and clarity

  • Abstract
  • Out-of-office experiences
  • Guides for the gray areas
  • What would you practice?
  • Comfort and clarity
  • References

Clear-cutting answers are rare when someone you're close to is hurting and you have the power to ease their pain. Thinking about these situations earlier they popular upward can arrive somewhat easier to gear up your personal guidelines. Counterbalance the ethical questions and opinions with land and federal laws. This will assistance yous make comfortable, well-thought-out decisions. In turn, the clarity and condolement of your personal guidelines can inspire students and colleagues every bit they form their own arroyo to these questions.

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Drs. Latessa and Ray are faculty members of the Mount Expanse Wellness Educational activity Center Family Practice Residency Program in Asheville, N.C.

Conflicts of interest: none reported.

Transport comments to fpmedit@aafp.org.

References

evidence all references

1. Chambers R, Belcher J. Cocky-reported intendance over the past x years: a survey of general practitioners. Br J Gen Pract.1992;42:153–156. ...

2. Christie JD, Rosen IM, Bellini LM, Inglesby TV, Lindsay J, Alper A, Asch DA. Prescription drug use and cocky-prescription among resident physicians. JAMA. 1998;280:1253–1255.

three. Hughes PH, Brandenburg N, Baldwin DC Jr, Storr CL, Williams KM, Anthony JC, Sheehan DV. Prevalence of substance use among US physicians. JAMA. 1992;267:2333–2339.

four. Wachtel TJ, Wilcox VL, Moulton AW, Tammaro D, Stein MD. Physicians' utilization of health care. J Gen Intern Med. 1995;x:261–265.

5. Westfall JM, McCabe J, Nicholas RA. Personal use of drug samples by physicians and role staff. JAMA. 1997;278:141–143.

6. Aboff BM, Collier VU, Farber NJ, Ehrenthal DB. Residents' prescription writing for nonpatients. JAMA. 2002;288:381–385.

seven. La Puma J, Stocking CB, La Voie D, Darling CA. When physicians treat their own families: practices in a customs hospital. N Engl J Med. 1991;325:1290–1294.

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