Central PA Medicine Spring 2018 - 22

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Community, Health & Wellness

Requests to treat family and friends are to keep adequate records of medical care,
pervasive, and physicians often feel pressured failure to provide alternative plans of treatand conflicted when asked to do so. A 1991 ment, failure to obtain medical consent,
survey reported that 99 percent of physicians providing care outside the scope of clinical
had received requests from friends or family expertise, failure to communicate with the
for medical advice, diagnosis, or treatment, physician of record, and failure to obtain
and 83 percent had prescribed medications informed consent in the case of a minor.5
for relatives.6
Also, difficult situations may arise in case of
a complication which occurs as the result
Usually, these requests are for minor illness of a physician treating a friend or family
or injury, and antibiotics, contraceptives, and member, including remorse on the part
analgesics are the most commonly prescribed of the physician, and anger on the part of
classes of drugs in these circumstances. But the family member or friend, leading to
occasionally physicians will go farther out on medical malpractice action or reporting of
the limb to prescribe sedatives, antidepres- the physician to his state's Medical Board.5
sants, and narcotic analgesics.7-9 In another Finally, Medicare prohibits payment for
study, 15 percent of hospital physicians services ordered or performed by a provider
reported serving as an attending for a loved for a family member.6
one, and 9 percent had performed elective
surgery on a relative.6 It is not surprising
After reviewing all of these factors, I feel
to me that physicians, an intelligent but that I am on solid ethical and practical
self-willed and independent group, will ground when I ask our participants to eschew
not infrequently choose to go against the prescribing for their family. This requirement
grain of ethical recommendations. Or more will not only reinforce the avoidance of
generously, perhaps they are simply unaware drugs that can trigger a relapse, but will
of the ethical guidelines - I don't recall any also help the participants to circumvent
training about these issues in medical school stressful situations which may arise when
(albeit a long time ago).
they unadvisedly act as a treatment provider
for their family and friends. Recovery is hard
Here are some of the pitfalls of caring for enough without the added pressure.
family and friends: failure to ask sensitive
but important questions, failure to do a
complete physical examination, failure

The Physicians' Health Program (PHP), a program of The Foundation
of the Pennsylvania Medical Society, the charitable arm of PAMED,
provides support and advocacy to physicians struggling with addiction or physical or mental challenges. The program also offers
information and support to the families of impaired physicians and
encourages their involvement in the recovery process.
Find out more at www.foundationpamedsoc.org.

22 Spring 2018 Central PA Medicine

REFERENCES
1. Code of Medical Ethics of the American Medical
Association. Chicago: American Medical Association
Press, 1847
2. The AMA Code of Medical Ethics' Opinion on
physicians treating family members. Virtual Mentor
2012; 14:396-397
3. Americal College of Physicians Ethics Manual, 6th
Edition. Ann Intern Med 2012; 156:73-104
4. Committee on Bioethics. Policy statement - pediatrician-family-patient relationships: managing the boundaries.
Pediatrics 2009; 124:1685-1688
5. No Appointment Necessary? Ethical Challenges in
Treating Friends and Family. Gold, K., et al. NEJM
2014; 371:1254-1258
6. When physicians treat members of their own families:
practices in a community hospital. LaPluma, J., et al.
NEJM 1991; 325:1290-1294
7. Self-prescribed and other informal care provided by
physicians: scope, correlations, and implications. Gendel,
M., et al. J Med Ethics 2012; 38:294-298
8. Personal use of medical care and drugs among Swiss
primary care physicians. Schneider, M., et al. Swiss Med
Weekly 2007; 137:121-126
9. Physician patterns in the provision of health care to
their own employees. Sansone, R., et al. Arch Fam Med
1995; 4:686-689
10. Medicare benefit policy manual: Chapter 15. Baltimore: Center of Medicare and Medicaid Services, 2013

http://www.dauphincms.org http://www.foundationpamedsoc.org

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