Doctors take an oath to “first, do no harm”, yet sometimes the ethical dilemmas they face can seem intractable. Treating friends and family is one such dilemma that doctors grapple with throughout their careers. On the surface, it may seem harmless or even beneficial for a doctor to provide medical care to loved ones. However, there are good reasons why most doctors avoid taking on a professional role with friends or family members.
The risks of dual relationships
Treating friends or family members creates what is known as a “dual relationship” for the doctor. In dual relationships, the doctor’s personal and professional relationship becomes intertwined. This blurring of boundaries can make objective, medically appropriate care much more difficult to deliver. Even the most well-meaning doctor may find it hard to avoid their emotional connection to a friend or family member from influencing their medical judgment.
For example, a doctor treating a close friend may downplay risky symptoms or fail to disclose difficult diagnoses out of a subconscious desire to avoid upsetting their friend. Conversely, anxiety about a loved one’s health could lead to over-testing, over-treatment or other medically unnecessary interventions. Neither scenario delivers ethical, high quality medical care oriented around the patient’s needs.
Informed consent issues
Treating friends also undermines the informed consent process which is essential to ethical care. Informed consent requires doctors to explain treatment options objectively so patients can make well-considered choices about their health. But a doctor’s personal relationship with a friend-patient can obscure objectivity. The friend may not feel empowered to ask questions or reject recommendations, believing the doctor “knows best”. This can result in the friend-patient receiving care they do not fully understand or actually want.
Confidentiality concerns
Doctors are obligated to maintain patient confidentiality under their code of ethics. But maintaining confidentiality with a friend-patient can be extremely difficult. The doctor may feel compelled to discuss the friend’s medical situation with mutual acquaintances out of concern for their well-being. Conversely, the friend-patient may inappropriately share private details about their other friends’ medical issues known by the doctor. Neither scenario upholds the confidentiality owed to patients.
Affected clinical judgement
Even the most ethical, conscientious doctor may find their clinical judgement is affected when treating someone they have an external relationship with. Studies show doctors order significantly more interventions for friends and family than medically indicated. One study found docs ordered over 400% more unnecessary CT scans for their loved ones. The emotional connection makes it much harder for doctors to maintain the objectivity and professional detachment essential to quality care.
Increased complaints and malpractice risk
Doctors who treat friends and relatives face a greater risk of complaints and lawsuits compared to other patients. This is because patients who have an external relationship with their doctor have different expectations and are more likely to feel disappointed or angered if outcomes are poor. Lawsuits from friend-patients also tend to be more emotionally charged and vigorous when issues arise.
Billing fraud
Billing practices are another area that gets ethically murky when doctors treat friends or family. Many doctors choose not to charge loved ones, which is ethically acceptable. However, waiving fees could constitute insurance fraud if the doctor bills insurance for care provided free-of-charge to a friend. Doctors may also face pressures to prescribe unnecessary medications or order non-essential tests to assist a friend in reaching their insurance deductible. Any billing irregularities could have serious consequences for a physician’s medical license.
Stress and burnout
Treating friends and loved ones can take a psychological toll on physicians. These relationships tend to foster unrealistic expectations and assumptions that the doctor is always available to provide advice or care. The dual role can leave doctors overwhelmed and burned out from constantly worrying about friends’ or family members’ health.
Alternative solutions
So if doctors can’t treat friends ethically, what should they do when a friend has a health concern? The most appropriate response is to maintain clear professional boundaries and recommend the friend book an appointment with an impartial doctor. The doctor can offer support by helping the friend find specialists or a second opinion if desired. If the friend’s issue is minor, web-based telehealth may be an option to avoid overburdening the doctor’s regular colleagues. When conflicts of interest make treating friends untenable, doctors have an obligation to guide them to alternate quality care.
Exceptions in emergency situations
The only scenario where it is considered ethically acceptable for doctors to treat friends is in emergency situations when no other medical care is accessible. For instance, it may be unavoidable for a doctor to provide lifesaving care to a friend who is injured while they are alone together away from health facilities. Similarly, a doctor may be compelled to intervene for a friend who collapses from a suspected heart attack or stroke while in their presence. But in these cases, the doctor should still transfer the friend to another provider as soon as the emergency is resolved.
Policies against treating friends
Most hospitals and clinics recognize the ethical hazards of doctors treating friends and family members. They have policies prohibiting doctors from serving as a primary or regular provider for anyone they have a personal relationship with outside of work. Doctors who violate these policies risk disciplinary action, including dismissal. These no-friends policies are in place to protect patients and preserve the integrity of the medical profession.
Detrimental to the doctor-patient relationship
At its core, the prohibition against treating friends is about preserving the sanctity of the doctor-patient relationship. Effective healthcare depends on patients’ ability to speak openly with doctors, ask uncomfortable questions, and receive unbiased counsel focused solely on their health. Personal relationships between doctor and patient can inhibit this openness and trust. Policies against doctor-friend treatment uphold the essential pillars of ethical, high quality care.
The bottom line
Despite good intentions on both sides, doctors treating friends is an ethical minefield. The preexisting personal relationship makes it nearly impossible for doctors to avoid conflicts of interests and lapses in professional judgement. While it may seem counterintuitive, the best way for doctors to effectively care for their friends is to say “thanks, but no thanks” when asked to provide medical treatment. Maintaining proper professional boundaries is key to delivering the honest, compassionate, confidential healthcare friends deserve.
FAQ
Why can’t doctors treat family members?
Doctors avoid treating family for the same ethical reasons they should not treat friends. Their personal connection makes it difficult to remain objective. Family relationships can cloud clinical judgement and compromise standards of care.
What if my friend just needs a prescription refill?
Refilling prescriptions for friends is still considered ethically questionable. It is best for doctors to avoid prescribing anything not urgently needed for friends or family. Even prescription refills should be handled by an impartial provider.
Can doctors treat other doctors as patients?
Doctors face the same conflicts treating other doctors as they do with treating friends. Most try to avoid providing care to other physicians they know personally. However, some limited treatment of other doctors may be unavoidable based on within-specialty referrals.
What about treating celebrities or VIPs?
Treating prominent patients like celebrities poses the same ethical pitfalls as treating friends. Doctors can be overly anxious to please or swayed by the prestige of caring for someone notable. Many physicians choose to avoid becoming doctors to the stars for this reason.
Could AI and telemedicine expand doctors’ ability to treat friends?
Emerging technologies like AI and telemedicine may allow doctors to provide some basic services to friends ethically in the future. But for sensitive, serious, or complex care, maintaining boundaries will remain key.
Conclusion
Doctors should not treat friends or family due to the near impossibility of avoiding conflicts of interest and lapses in professional judgement when personal and clinical relationships intersect. While disappointing a friend seeking care may feel awkward, it is the only way for doctors to preserve their ethical duty and deliver truly patient-centered medicine. In medicine, professionalism depends on separating the personal from the clinical. This is why doctors simply can’t be all things to the people they care for most.
