Originally published April 2014
At some point in their careers, most doctors will find themselves faced with having to decide whether to treat a family member, a friend, or even themselves. So, what's appropriate? What are the professional boundaries when it comes to self-treating or treating individuals a doctor knows personally?
The practice of medicine is based on a physician-patient relationship and requires acting in the best interests of patients. Knowing who a physician can or should treat, and under what circumstances, are valid questions in light of a physician's obligations. The integrity of a professional relationship, which is the basis of quality care, can be compromised if there is an emotional, familial, or personal affiliation. Treating a person with whom the physician has an intimate relationship can lead to serious consequences and potentially result in the loss of the right to practice.
Ideally, treatment of family and friends, as well as self-treatment, should be avoided. Physicians should also refrain from accessing their own health information or the confidential health information of family members or friends. Doing this can put physicians in conflict with privacy laws and the administrative protocols of the institution or facility that is the custodian or trustee of the health records.
Quality of care demands professional objectivity
There are several reasons for knowing and respecting boundaries, and for maintaining a professional relationship with patients. When the patient is a member of the family or a close friend, it may be difficult for a physician to obtain a detailed history, conduct sensitive examinations, or provide comprehensive treatment options. As well, maintaining confidentiality can be difficult, records may be inadequate, and other family members may expect similar attention.
A patient who is treated by a doctor with whom there is a personal relationship — either as a friend or family member — may not give accurate information or an exact history, or pursue a second opinion or alternative treatment, simply because they feel it is inappropriate to question the care of a doctor they "know." Similarly, a physician's objectivity and judgment may be hindered if they try to assess and treat their own medical conditions.
Through electronic record systems, physicians often have easy access to their own health information, as well as that of family and friends. Such access may be convenient, but inappropriate authorization or failing to follow the protocols of the institution or facility that is the custodian of the health record can lead to repercussions, even if patient consent has been obtained. Aside from the potential for a breach of privacy or a violation of the facilities' protocols, there is the possibility of medico-legal consequences if it is determined that a physician-patient relationship was created as the result of the physician reviewing and providing clinical comments on the information. For more information on this topic see "Protecting patient health information in electronic records" as well as the CMPA's Electronic Records Handbook [PDF].
When circumstances compel treatment
There are times, however, when physicians will treat someone with whom they have a personal relationship. These are viewed as exceptions that can occur for minor health conditions or when there is need for emergency care and no other physician is readily available.
Under these circumstances, the doctor must transfer care to another qualified health professional as soon as possible and practical. The decision to treat or to refer the patient to another physician should be documented.
The Canadian Medical Association's Code of Ethics states: "Limit treatment of yourself or members of your immediate family to minor or emergency services and only when another physician is not readily available; there should be no fee for such treatment.1"
The College perspective
Some medical regulatory authorities (Colleges) have outlined what is expected of physicians when considering treatment of family members, or self-treatment. They generally cite concerns for quality of care and state that occasions where this practice is acceptable are very limited.
As well, most Colleges have policies on prescribing. Often these are similar to the policies on treating family or friends: physicians should not write a prescription for themselves or family members for controlled drugs or any drugs that are addicting or habituating, even when another physician is in charge of managing the medication.
A physician's prescribing privileges may be revoked if narcotics or controlled drugs are prescribed to family members or if a physician self-prescribes these substances. Treating or prescribing any drugs, especially controlled substances, to oneself or to family or friends could lead to allegations of professional misconduct.
Defining the parameters
Providing care generally includes examining a patient, ordering tests and interpreting results, making and communicating a diagnosis, and prescribing medications or taking other measures.
As noted, only in exceptional circumstances, such as care for minor or emergent conditions, is the treatment of family and friends tolerated. A minor condition can be defined as one that is not urgent or serious — essentially conditions that require short-term, routine care and do not indicate a more serious condition requiring medical expertise. Emergent care occurs when someone appears to be experiencing severe suffering or is at risk of serious bodily harm if medical care is not provided quickly.
A family member or friend can be a physician's spouse or partner, parent, child, sibling, grandparent, or grandchild. It may also be the immediate family of a physician's spouse or partner. It includes other individuals with whom the doctor has a personal or emotional involvement and that the physician would have difficulty providing objective and professional diagnoses and care.
Sometimes it can be difficult to evaluate whether there is a personal relationship with an individual. When this occurs, the doctor should consider the impact that knowing the individual personally could have on the quality of the treatment provided. Here are a few questions that may help physicians determine the nature of their relationship with individuals:2
- Could the relationship impact acting in this individual's best interests?
- Could treating this person be difficult because it would be too uncomfortable to ask the questions required to make a proper diagnosis? Could this person feel uncomfortable providing truthful answers that are necessary for the diagnosis?
- Would the relationship with this person make it difficult to maintain patient confidentiality or make a mandatory report?
- Would it be difficult to allow this person to make a personal healthcare decision that does not adhere to the medical advice given?
Members should consult the policies of the College in their jurisdiction for more information on the professional obligations for self-treatment or the treatment of family and friends. Members may also want to call the CMPA for guidance on this issue.
1. Canadian Medical Association, "CMA Code of Ethics," 2004. Accessed April 4, 2014 from: http://www.cma.ca/code-of-ethics
2. College of Physicians and Surgeons of Ontario, "Treating Self and Family Members" November 2006. Retrieved November 15 2013 from: http://www.cpso.on.ca/uploadedFiles/policies/policies/policyitems/treating_self.pdf