Family vs. Physician
How do you feel when you have a patient who is also a physician? Or a patient whose close family member is a physician? Is this a welcome interaction for you, because you can talk in “doctor speak” to the fellow physician and not have to worry about being understood? Or is it welcome because you think the patient’s home care will be better, since the physician will better understand what needs to be done? Or, conversely, do you dread seeing “doctor” on the chart because the physician will ask a lot of questions? Or undermine your authority with the patient? Or challenge your decision-making?
I have been pondering this idea as I explained some medical information to several family members. In what ways can I be helpful to the situation, and where do I want to avoid making more work for the doctor caring for my family?
It is difficult to be a physician and a family member. Beginning with the temptation to give in and “just call something in for me,” it’s difficult to balance these roles. We are accustomed on a daily basis to being healthcare professionals and providing care for the people in front of us. So when the person in front of us is at home, not in the clinic, and is a family member, not a stranger, it feels normal and natural to listen to the symptoms, formulate a diagnosis and move forward with a plan. That process has been deeply ingrained in us for years, after all. But if I am diagnosing and treating my child, for example, who is being my child’s mother—asking questions about what she needs to do to comfort and relieve him during the course of treatment, cooking tempting foods to coax him to eat and measuring the meds to keep his fever at bay? And if I am diagnosing and treating my mother, who is being her adult child—asking the questions, talking about memories of the past to encourage Mom to tell her stories and making sure she has a blanket that she likes when her feet get cold? Conversely, if I am being my child’s mother, comforting and caring but also trying to treat him, who is asking hard questions about the treatment plan, thinking about the zebras that are very unlikely—but possible—in this scenario, and looking past my child’s short-term discomfort to determine what will bring the most long-term relief?
The longer I carry out the varying activities of doctor and family member, the more convinced I am that they are very different roles. Of course, I have treated family members before, and there is a good chance I will do so again. But I am increasingly aware that, when I try to fill two different roles for someone I love, I end up scrimping on one or both of them. I either shift into clinical mode and fail to provide the care, comfort and love my family member needs, or I shift into mom (daughter, niece, etc.) mode and fail to maintain the objectivity needed to accurately assess a diagnosis and treatment plan. And I haven’t even mentioned the discomfort of family pressure to treat someone a certain way (“Just call in some Amoxicillin for my throat. I know my body and I know this is strep.”) that makes it even harder to follow the evidence-based practice we would use in our offices!
A number of years ago, our Medical Board here in Texas determined that casual/unofficial medical care of a friend or family member is an ethical violation. Now, the cynical among us have looked at the monetary amounts raised through fines for doctors committing this violation and have wondered if this particular ethical concern is somewhat self-serving on the part of the Medical Board. But aside from that issue, the practical outcome of this Medical Board decision was to force us Texas doctors to see our family members in clinic if we want to treat them. While it’s arguably a bit more of a hassle than the old system (calling in an antibiotic when I looked in a crying kid’s ear at home at 2 a.m. and saw otitis), taking my family members into the clinic where I practice and having to document an official visit changes my mindset as I examine that person. I am in a clinical place and it’s easier to put myself into full doctor mode, thinking fully formed diagnostic thoughts instead of off-the-cuff reactions to a loved one in pain or distress.
Personally, I do not believe it is unethical to serve as the doctor for a loved one in general, though there are clearly areas in which an ethical boundary could easily be crossed (prescribing controlled substances for a loved one, providing psychiatric care for a loved one, etc.). I have decided, though, that it is easier and cleaner to fill one role at a time. Since most of the time there are a variety of qualified people who can be my family members’ doctors, I opt to be their mother/wife/daughter/etc. I’m the only one who can fill that role. Of course, as I act as mom/wife/daughter, I still have all my medical training and knowledge at my disposal. I just use it as a helpful way to ask better questions and discuss deeper ideas with the doctor, as well as to translate the “doctor speak” for my family member. In this way, I am fully present as family member and I allow the doctor to be fully present as doctor.