Can you be the doctor of your family members/friends?

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lalex

lalex

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If so, how does that work with insurance? Couldn't insurance deny claims?
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lalex said:
If so, how does that work with insurance? Couldn't insurance deny claims?
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They can deny claims for any number of reasons but treating family is generally not one that I'm familiar with.

However, even if they did that is far from the only reason not to treat family and friends.
 
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There are also some components of a complete physical exam you might not feel as comfortable doing on family and friends or they may not be as comfortable having you perform. And you shouldn't skimp or you'll be doing them a disservice. So send them to someone where the interaction is less personal and more clinical but every leaf gets unturned. Medicine is not just about writing scrips, it's about palpating and probing and asking uncomfortable questions.
 
Say a family member had something very obvious, let's say strep throat. You are a pediatrician or family med doc and you have seen strep throat 1000 times - you know for absolute certain that is what they have. Can you give antibiotics legally/ethically?
 
ChrisMack390 said:
Say a family member had something very obvious, let's say strep throat. You are a pediatrician or family med doc and you have seen strep throat 1000 times - you know for absolute certain that is what they have. Can you give antibiotics legally/ethically?
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Legally, yes. Although I've heard that some hospitals strongly discourage their docs from doing this for family members without having them seen in the clinic/urgent care.
Probably a bit of an ethical grey zone.
 
ChrisMack390 said:
Say a family member had something very obvious, let's say strep throat. You are a pediatrician or family med doc and you have seen strep throat 1000 times - you know for absolute certain that is what they have. Can you give antibiotics legally/ethically?
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This is a good question. According to Glandzburg, yes this is legal. I'm not too sure about the ethical component, personally. Any type of follow up for whatever reason in situations like these would have to be done by another physician, of course.
 
ChrisMack390 said:
Say a family member had something very obvious, let's say strep throat. You are a pediatrician or family med doc and you have seen strep throat 1000 times - you know for absolute certain that is what they have. Can you give antibiotics legally/ethically?
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You'd still need a chart and proper documentation. It will not be overlooked by your state medical board if anything goes wrong. Can you really expect an honest history from a relative?
 
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This is a terrible idea. First of all, you are never certain of anything. Second of all, you would need to charge them for your services, or else you would have committed fraud. If you treat your family for free, why won't you treat others for free? Third, what if you are wrong? Things like strep throat are actually hard to diagnose in some cases, particularly without lab tests, which you won't have over the phone or in your home. What if you gave your family member Stevens-Johnson Syndrome by prescribing antibiotics unnecessarily without knowing their previously undisclosed allergy? Would you be OK with them suing you to cover their considerable expenses? How are you going to chart? If you don't chart and something bad happens, you will lose your license, bingo bango bongo. Imagine working for that long only to lose your license because you wrote the wrong prescription to a family member.

I've been a doctor for more than a decade. I never, ever treat family members, friends, or colleagues. I am friends with many who have the same policy. You will end up knowing hundreds of docs by the time you're done training. Refer your family to one of them. Stay out of it.
 
Dad owns private practice.... whenever i would get MRI's for sport related injuries insurance would pay for them.
 
typhoonegator said:
Second of all, you would need to charge them for your services, or else you would have committed fraud.
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Is there case law on this? I don't see how treating someone for free counts as deception to secure an unfair gain.
 
lalex said:
If so, how does that work with insurance? Couldn't insurance deny claims?
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LOL.gif

http://www.ama-assn.org/ama/pub/phy...l-ethics/code-medical-ethics/opinion819.page?
 
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ChrisMack390 said:
Say a family member had something very obvious, let's say strep throat. You are a pediatrician or family med doc and you have seen strep throat 1000 times - you know for absolute certain that is what they have. Can you give antibiotics legally/ethically?
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But if you are wrong... I knew a elderly family doc who treated his adult daughter for bronchitis for an entire winter. He's seen it 1000 times, he was certain it was what she had. She never got better. Turned out she had lung cancer. She died. Her eldest child was 17; her father was never the same.
 
LizzyM said:
But if you are wrong... I knew a elderly family doc who treated his adult daughter for bronchitis for an entire winter. He's seen it 1000 times, he was certain it was what she had. She never got better. Turned out she had lung cancer. She died. Her eldest child was 17; her father was never the same.
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How is that different than being wrong about any other patient?
 
Law2Doc said:
It's not fraud.
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Routine waiver of copays is fraudulent mis-statement of the actual charge and is explicitly Medicare fraud. http://oig.hhs.gov/fraud/docs/alertsandbulletins/121994.html

I guess if you don't even see them in the office, don't schedule appointments for them, and don't chart, then you could avoid charging their insurance for the visit altogether. That would be tough in EPIC, though, and you really would not be providing a level of care that would be commensurate with your non-relative patients.
 
It depends a lot. Standard stuff is usually no issue. Like I would always do checkups with my pediatrician, but I rarely ended up at the doctor for most minor illnessses or injuries. For refills, etc, sometimes my dad would just prescribe them and pick them up out of convenience. I got a pair of flu shots (during the swine flu) in the parking lot of my after high school job during my lunch break.

Controlled (schedule II or III) is an issue for family/self outside of emergencies. It will certainly be looked at and you will need a good reason to explain it.
 
What about "professional courtesy"? I've heard that traditionally doctors don't charge to treat each other's families so that you don't run into those ethical problems. Is that a real thing?
 
Goro said:
You're obviously not a parent.
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Of course it is more upsetting (and devastating in that case) than being wrong about any other patient. I'm not so sure it makes you more likely to be wrong though.
 
LizzyM said:
But if you are wrong... I knew a elderly family doc who treated his adult daughter for bronchitis for an entire winter. He's seen it 1000 times, he was certain it was what she had. She never got better. Turned out she had lung cancer. She died. Her eldest child was 17; her father was never the same.
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In all fairness to him, it was lung cancer. She probably would have died anyway- most symptomatic lung cancer patients already have some metastatic spread, giving them a five-year survival rate of 3.9%.
 
LizzyM said:
But if you are wrong... I knew a elderly family doc who treated his adult daughter for bronchitis for an entire winter. He's seen it 1000 times, he was certain it was what she had. She never got better. Turned out she had lung cancer. She died. Her eldest child was 17; her father was never the same.
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0-100 real quick.
 
LizzyM said:
But if you are wrong... I knew a elderly family doc who treated his adult daughter for bronchitis for an entire winter. He's seen it 1000 times, he was certain it was what she had. She never got better. Turned out she had lung cancer. She died. Her eldest child was 17; her father was never the same.
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Also, to be fair w/ re: to your example, this is not something that hasn't been missed before, even w/ non-relative specialists treating. It happened to an in-law of mine, and it has happened w/ a couple of patients I've known as well.

It may even have been ~25% of the time according to this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874519/
Yes, this is British, and yes, it's now over 10 years old, however, it could easily occur anywhere.

I think the difference is the personal impact would be greater with the relative--however, it can and has been missed by radiologists. I think if you aren't related you may be more able to stand back and considered more objectively possible DDxs. It's OK to use your education and ask questions or even suggest things; but it's better to let the specialist carry it, and just advocate and watch. One can always change physicians if things are going awry or you education, experience, and interactions with patient tell you that perhaps something was missed. Sucks, however, to miss lung ca, b/c early treatment can make a difference for some.

So if you stand back as advocate, you may be more able to consider the necessity for the evaluation of others--changing physician, medical center, etc. This is NOT necessarily an easy thing to do; but, with a lot of work and persistence it is possible, if it is really necessary. If not, you stressed the hell out of yourself for nothing. But anyone can advocate. It's just better to be able to step back and look at everything and that can get really tough at times with family. OTOH, with a knowledgeable person, the vigilance re: advocacy can pay off.
 
Yes, it might have been fatal anyway but the old doc blamed himself for a 4-5 month in delay in treatment. Certainly physicians feel bad about missing a diagnosis and having a patient die but in this case the doc's daughter was in her early 40s with a 25 pack year history of smoking and "Dad" couldn't /wouldn't entertain that in the differential. If it were a woman unrelated to him he might have been more objective and more thorough in looking at the whole picture.

Do you want to take an unflinching social history from a family member including illegal drug use and sexual practices?
 
LizzyM said:
Yes, it might have been fatal anyway but the old doc blamed himself for a 4-5 month in delay in treatment. Certainly physicians feel bad about missing a diagnosis and having a patient die but in this case the doc's daughter was in her early 40s with a 25 pack year history of smoking and "Dad" couldn't /wouldn't entertain that in the differential. If it were a woman unrelated to him he might have been more objective and more thorough in looking at the whole picture.

Do you want to take an unflinching social history from a family member including illegal drug use and sexual practices?
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True, and sad--adding even more guilt to impair the grieving process.
 
ChrisMack390 said:
Say a family member had something very obvious, let's say strep throat. You are a pediatrician or family med doc and you have seen strep throat 1000 times - you know for absolute certain that is what they have. Can you give antibiotics legally/ethically?
Click to expand...

How do you know that it's strep throat and not extensive esophageal candidiasis from an immunocompromised state (i.e., AIDS)? Or oral gonococcal pharyngitis?
 
group_theory said:
How do you know that it's strep throat and not extensive esophageal candidiasis from an immunocompromised state (i.e., AIDS)? Or oral gonococcal pharyngitis?
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Because you swabbed their throat and the 2 lines showed up on the test and/or bacteria grew in the petri plate.
 
Cotterpin said:
What about "professional courtesy"? I've heard that traditionally doctors don't charge to treat each other's families so that you don't run into those ethical problems. Is that a real thing?
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Not if you accept Medicare. You have signed a contract that affirms that you will not charge anyone less than you charge a Medicare patient.
 
LizzyM said:
Do you want to take an unflinching social history from a family member including illegal drug use and sexual practices?
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This is why we don't take directed donor blood products from relatives.
They are too embarrassed to give an accurate history.
 
gyngyn said:
Not if you accept Medicare. You have signed a contract that affirms that you will not charge anyone less than you charge a Medicare patient.
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Is it a real thing that doctors who don't accept Medicare do?
 
gyngyn said:
One could. If you care for the poor, you really don't have the option, though.
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I don't feel like you're answering the question I'm asking. Are there physicians out there who follow the traditional "professional courtesy" thing or not?
 
Cotterpin said:
I don't feel like you're answering the question I'm asking. Are there physicians out there who follow the traditional "professional courtesy" thing or not?
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You can't legally do this if you care for Medicare patients. Thus, though it is technically possible. I don't know anyone who can do this.
 
gyngyn said:
You can't legally do this if you care for Medicare patients. Thus, though it is technically possible. I don't know anyone who can do this.
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Okay. You don't know anyone who doesn't accept Medicare. So I guess you can't answer my question.
 
gyngyn said:
Yes, it is only technically possible for docs who don't accept Medicare so I haven't seen this happen.
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Yeah, I get it. I feel like you've said the exact same thing to me like four times in a row. Thank you for trying. If I ever meet a doctor who doesn't accept Medicare, then I will ask them this question.
 
typhoonegator said:
Routine waiver of copays is fraudulent mis-statement of the actual charge and is explicitly Medicare fraud. http://oig.hhs.gov/fraud/docs/alertsandbulletins/121994.html

I guess if you don't even see them in the office, don't schedule appointments for them, and don't chart, then you could avoid charging their insurance for the visit altogether. That would be tough in EPIC, though, and you really would not be providing a level of care that would be commensurate with your non-relative patients.
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If you bill Medicare for it but waive the copay yes that's a problem. If you don't charge them at all and don't submit insurance, it's not going to be the same issue. It likely won't come up. You might be breaching your contract with Medicare and there may be consequences but that isn't the same as the crime of fraud (which you can go to jail for).
 
LizzyM said:
But if you are wrong... I knew a elderly family doc who treated his adult daughter for bronchitis for an entire winter. He's seen it 1000 times, he was certain it was what she had. She never got better. Turned out she had lung cancer. She died. Her eldest child was 17; her father was never the same.
Click to expand...
You act as though the amount of time between being seen initially and diagnosis would have changed prognosis. This is entirely unlikely in lung cancer.

On topic: while this is considered a no-no on exams, in real life it is very common and not a big deal at all.
 
I dont know why people are arguing over this. Its quite simple. You are not completely objective when treating close friends and family. The objectivity is one trait that defines a physician and its just not there in this scenario.
 
Well in a medical journal article and according to the ACS this concept has come up more than once:

"There are three main types of lung cancer. Knowing which type you have is important because it affects your treatment options and your outlook (prognosis). If you aren’t sure which type of lung cancer you have, ask your doctor so you can get the right information." http://www.cancer.org/cancer/lungcancer/
Also the British Medical article above ^.

Truth is there isn't perfect objectivity w/ humans--even in science/medical science. It's more like there are degrees of striving for objectivity--and there must be a balance between striving for objectivity and empathy. There are people than can do this when it's a very close family member. I have witnessed this, but I still also believe it's best to stand as advocate with the loved one, and work together with hopefully well-chosen, reputable physicians.

And let's face it. If you are some other physician, but not a surgeon, and your loved one needs surgery, you have to choose wisely and put a lot of trust in that surgeon, b/c you can't do it. In fact there is a lot trust-sharing all the way around--even among colleagues etc.

Yes, I have seen those with substantial medical knowledge/experience be very, very helpful in advocacy and bringing certain things to light. It really depends upon the person. Seriously, not everyone is the same. Not everyone loses total control and the ability to strive for objectivity when their loved one becomes seriously ill. (There are plenty of actual events I could share, but I can't reveal them online.)

And seriously, if you are a highly empathetic person, although your patients aren't your relatives or other close loved ones, you don't totally suspend your strong degree of empathy. It's there, and it's a good thing. It is part of the necessary impetus for strong advocacy. It's just that you learn to put if off to the side somewhat, so to speak, b/c you have to focus on the priorities of what you know--data about said condition, and what you need to know, in order to move forward in a highly productive and helpful manner. It's not an act of absolute dispassion. It's an act of focused discipline.

Cotterpin said:
Is it a real thing that doctors who don't accept Medicare do?
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Many years ago, my mother, an ER/ED RN, received professional curtesy, even at times for her children, from physicians--even a few surgical consults. Back then, it wasn't a big deal. But things, as have been noted above, have changed. I would think today, if/when it happens, it's rare and/or done on the down-low, so to speak. So, so much has changed.
 
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gyngyn said:
Not if you accept Medicare. You have signed a contract that affirms that you will not charge anyone less than you charge a Medicare patient.
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I think in the modern era, it is more that there is "Cadillac" insurance for doctors and their families, provided cheap or free as part of employment. Only thing I have ever paid a copay for is prescriptions. Nothing for ER, appointments, referrals, or even surgeries.
 
Cotterpin said:
Is it a real thing that doctors who don't accept Medicare do?
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Professional courtesy, e.g. providing free care to the families of fellow physicians pretty much went out of style after health insurance arrived on the scene and you could get paid for services that had previously been provided for free. Keep in mind that it was no picnic to be the go-to OB for the wives of all the docs in town.
 
Tenk said:
You act as though the amount of time between being seen initially and diagnosis would have changed prognosis. This is entirely unlikely in lung cancer.

On topic: while this is considered a no-no on exams, in real life it is very common and not a big deal at all.
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That's not the point. The point is that a physician's daughter did not get a correct diagnosis and optimal treatment in a timely manner. That is a failure of our medical system. The dad blamed himself. Prompt attention may not have changed the outcome but self-blame and grief are powerful things and the self-blame is avoidable if one avoids treating family.
 
gyngyn said:
Not if you accept Medicare. You have signed a contract that affirms that you will not charge anyone less than you charge a Medicare patient.
Click to expand...
And interestingly enough, those most likely to ask for me to "waive their co-pay" are doctor's wives and nurses who should know better (and have a lot more money than the Medicaid patients).
 
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