Procedure on Family

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BobLoblaw78

BobLoblaw78

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Would you be willing to do a procedure on a family member? I think things changed from physicians freely treating family members, to it being frowned upon during my training. But I feel like real world is a bit different. I am struggling with doing the injection myself that is low risk versus having someone I know less well do it. Plus, I really need the money!
 
BobLoblaw78 said:
Would you be willing to do a procedure on a family member? I think things changed from physicians freely treating family members, to it being frowned upon during my training. But I feel like real world is a bit different. I am struggling with doing the injection myself that is low risk versus having someone I know less well do it. Plus, I really need the money!
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I have
 
I'd do a joint or lumbar procedure on family/friend - done several for friends so far.

Would send to someone I trust for any cervical procedure or SCS/MILD/etc. in the 1:1,000,000 chance something catastrophic happened.
 
Not to sound arrogant but I have pretty high confidence in myself to do it right. Can say the same about a few of my colleagues but plenty of local docs I'd trust less than myself. I'm talking about procedures I'm comfortable with. Anything I don't do a lot of, I'd send to someone who I think can do it better than me.

runfastnow said:
in the 1:1,000,000 chance something catastrophic happened
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On the flip side, if you sent out, and something catastrophic did happen, you'd probably wish you had done it yourself.
 
I think it just depends on the situation. I sent my grandma to my partner. Not because I didn't feel comfortable but because I just didn't want it to become my relationship with her. Aunts calling when she is having an issue and wondering about med changes, getting her in for this or that, the conversation when we are together all about pain management, etc. I didn't want that to be how we spent the rest of our time interacting, and I knew my partner would do a good job and take great care of her. Had I not had him, or someone I felt comfortable with treating her I would have probably done the procedure and helped out more.
 
drrosenrosen said:
I've done injections for both of my in-laws. Do everything above board - write a consult note, review imaging, go over med list and history, document procedure, bill insurance.
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I’m assuming these are in-laws you like 😉


Personally, I wouldn’t inject my own friends and family because I don’t think it requires a level of skill that my colleagues may not have. I like keeping things low drama. Also I do not want to see their butt cracks.
 
RoloTomassi said:
Not to sound arrogant but I have pretty high confidence in myself to do it right. Can say the same about a few of my colleagues but plenty of local docs I'd trust less than myself. I'm talking about procedures I'm comfortable with. Anything I don't do a lot of, I'd send to someone who I think can do it better than me.


On the flip side, if you sent out, and something catastrophic did happen, you'd probably wish you had done it yourself.
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I think having minimal emotional or purely professional attachment to patients - especially in relation to higher risk procedures - is best and how I operate best. So if someone I care about had a bad complication because I referred to a well respected colleague that I would have perform same procedure on me that is something I could live with.

Me causing a bad complication to a family member or someone I have true emotional connection with - could not live with myself. Regardless of my skills (or lack there of) bad things happen and I'd prefer not to have it happen to someone I truly care about by my own hand. I've done hip injections and lumbar injections for my wife, close friends, etc. but would never do cervical ILESI, but got a guy I'd trust with my neck that I'd send her to.
 
I needed a cervical epidural a few years back and had a hell of a time deciding who I would let poke me locally.
 
i may know someone who did PRP on their knee hip and shoulder. Hip was the hardest.
 
I believe it is technically considered unethical to do a procedure on a family member especially an immediate family member

That being said, there are some exceptions. For example if you are in a rural area and no one else within a reasonable radius has the expertise to do that procedure you can do it but if you are the hospital you need to run it by the CMO first

or so I'm told....😉
 
You are risking your medical license. I am aware of board policies that explicitly prohibit treating family members unless it is minor, emergency treatment with full documentation.

The times have changed and not always for the better.
 
pastafan said:
You are risking your medical license. I am aware of board policies that explicitly prohibit treating family members unless it is minor, emergency treatment with full documentation.

The times have changed and not always for the better.
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I have heard this too. In fact the AMA I believe has frowned it.
 
Just to clarify, my treatment of family members has been one-off affairs - CMC injection, SIJ injection for subacute pain. I would never take on chronic management of a family member.
 
lobelsteve said:
I injected my knee a month ago. Painless. But now if injecting anyone I call them sissies if they make a peep.
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If you bill your own insurance for a self-performed procedure, it might make their computer system implode, Y2K style.
 
The problem is, every pain physician I know are friends. So now what?

I had a good friend inject my wife's elbow with PRP. She complained so much about that I injected her foot (PRP). I wouldn't do it again.

But I have inject a lot of friend's spouses. Now that I think about it, none of them have come back for a second round. I suspect there is a lesson somewhere in that I should learn.
 
oneforfighting said:
In that situation now. Did you end up going through with it?
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Yes. Went back to work an hour later. Worked well but took a few years to almost fully settle down. It cost me 3k thru my high deductible insurance plans. Nuts. Some groups really do have superior insurance contracts.
 
I treat family all the time. Injections, ESIs, RFs. Order imaging too. I have the confidence I won’t make a mistake. I see no problems with the ethics and have no concern about a board because everything is justifiable. No prescriptions for controlled but that goes without saying.
 
Don't worry about boards. Docs have been convicted of terrible things--fraud, pill mills, negligent homicide, all have their licenses. Look how much it took to get Dr death's license revoked
 
Treating family/friends opens up ethical concerns because your close relationship opens you up to bias, both good and bad. You may order an MRI when you shouldn't (and thus chase things that don't matter), do an injection to help when you probably shouldn't, start a medication when you probably shouldn't etc. That's not even counting if something catastrophic happens.

On the flip side, an orthopedic surgeon I once worked with treated all his family members. His argument was "Why would I send them to someone else when I'm the best?" Obviously hubris is involved, but it's a fair argument.

When I was doing my anesthesia residency I had several nurses and residents I know request me to do their anesthesia. This is an honor and of course I was happy to help. It is temping to try to go above and beyond and give them gold-star treatment, but my program director gave me the best advice I've ever heard regarding this situation:

"They are requesting you to help them because they trust you and like the way you do things. Don't change what you do because of who it is."

If you choose to treat family/friends, do it 100% the same as you would for anyone else.
 
I know a spine surgeon who did his wife’s fusion. She is all kinds of jacked up and has psych issues and who’s to say if he’s responsible 😵 clearly he thought well of his own skills but he’s not someone I ever would have referred to and that’s before knowing he cut his own wife.
 
Agast said:
I know a spine surgeon who did his wife’s fusion. She is all kinds of jacked up and has psych issues and who’s to say if he’s responsible 😵 clearly he thought well of his own skills but he’s not someone I ever would have referred to and that’s before knowing he cut his own wife.
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OMG!
 
MD87 said:
If you bill your own insurance for a self-performed procedure, it might make their computer system implode, Y2K style.
Click to expand...
I wonder if the peer to peer docs who have an mri ordered get to deny their own scan orders? Do they get to call themselves and ask for time dated stamps of PT notes with video camera evidence documenting the effort?

So doc tell me what’s going on (so I don’t have to read your same information in written form)?
 
i dont provide my parents nor other family members with treatment.

i provide them with information on their illness that they can go to their PCP or specialist to discuss more cogently. i also tell them how to approach their docs with questions and concerns.

there is bias involved in their treatment from the start that you cant avoid. i highly doubt family members are seeing their PCP and asking for a referral to see you... for me, that is on the steep slope ethically.
 
There’s bias of all types in medicine. Financial incentive to do an injection rather than more conservative care. How often do we make decisions based on what insurance dictates rather than how we would prefer to practice. Why do I refer every patient to the in network neurosurgeon, even if I think there’s a better surgeon in the competing hosptial system? However, for some reason the AMA frowns upon anything involving family members. I personally would avoid treating family members, but I don’t think the “ethical” argument really holds water with medicine today.
 
first, if you have an established documented doctor-patient relationship, i concur that an ethical argument against treatment is less potent. i still wouldnt do it, mostly because of expectations.

i would put the caveat on the above to not include certain medications. too much risk for misuse or misinterpretation of purpose of medications. for example, one of the local physicians lost his license because he was prescribing his wife vicodins.


second, i always refer patients to the best neurosurgeon/spine surgeon even if they work in a competing hospital system. i always refer patients to where they will get the best care.

i dont see why any of us wouldnt....
 
Ducttape said:
first, if you have an established documented doctor-patient relationship, i concur that an ethical argument against treatment is less potent. i still wouldnt do it, mostly because of expectations.

i would put the caveat on the above to not include certain medications. too much risk for misuse or misinterpretation of purpose of medications. for example, one of the local physicians lost his license because he was prescribing his wife vicodins.


second, i always refer patients to the best neurosurgeon/spine surgeon even if they work in a competing hospital system. i always refer patients to where they will get the best care.

i dont see why any of us wouldnt....
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My hosptial system pushes against me even referring diagnostic testing out of network, I’m sure most large hosptial systems are the same.
 
dipriMAN said:
My hosptial system pushes against me even referring diagnostic testing out of network, I’m sure most large hosptial systems are the same.
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I'm sure they would never influence your referral patterns. That would be unethical.

I am 100% certain they just "wanted to inform you of your 'system leakage' data to see what they can improve to earn your referrals." They will in no way punish you in little non-traceable ways in the future. /s
 
For a quick on-topic anecdote, I had a pain doctor friend refer his friend's mother to me for a one-shot visco. She's visiting from India and is a cash-pay patient. Happy to help her, so I set her up for a new patient appointment at which time I'll give an Rx and a GoodRx coupon so she can pick up at a local pharmacy then return for me to inject. Same as I would do for any other cash-pay patient, no cutting corners.

As a side note, it's amazing how absolutely freeing not dealing with insurance is. Wow.
 
macman said:
I believe it is technically considered unethical to do a procedure on a family member especially an immediate family member

That being said, there are some exceptions. For example if you are in a rural area and no one else within a reasonable radius has the expertise to do that procedure you can do it but if you are the hospital you need to run it by the CMO first

or so I'm told....😉
Click to expand...
why is considered "unethical"? make no sense to me just because someone says so. what's so "unethical" about it? who cares more about your family member than yourself?
 
drrosenrosen said:
Just to clarify, my treatment of family members has been one-off affairs - CMC injection, SIJ injection for subacute pain. I would never take on chronic management of a family member.
Click to expand...
what's the difference? one-off vs. chronic pain management?
 
Ferrismonk said:
Treating family/friends opens up ethical concerns because your close relationship opens you up to bias, both good and bad. You may order an MRI when you shouldn't (and thus chase things that don't matter), do an injection to help when you probably shouldn't, start a medication when you probably shouldn't etc. That's not even counting if something catastrophic happens.

On the flip side, an orthopedic surgeon I once worked with treated all his family members. His argument was "Why would I send them to someone else when I'm the best?" Obviously hubris is involved, but it's a fair argument.

When I was doing my anesthesia residency I had several nurses and residents I know request me to do their anesthesia. This is an honor and of course I was happy to help. It is temping to try to go above and beyond and give them gold-star treatment, but my program director gave me the best advice I've ever heard regarding this situation:

"They are requesting you to help them because they trust you and like the way you do things. Don't change what you do because of who it is."

If you choose to treat family/friends, do it 100% the same as you would for anyone else.
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I agree with you when treating family/friends, you should do exactly 100% as you would for anyone else.

Wait, I treat all my patients like my friends...

Don't understand why close relationship with patients, friends/family members or not "open you to bias"...make no sense to me...you are saying basically because it's your family members/friends, you might end up doing things you wouldn't do otherwise.

It's a huge assumption without much to back it up.
 
drpainfree said:
why is considered "unethical"? make no sense to me just because someone says so. what's so "unethical" about it? who cares more about your family member than yourself?
Click to expand...
you answered the question yourself.

AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members

The AMA Code of Medical Ethics' opinion on physicians treating family members.
journalofethics.ama-assn.org journalofethics.ama-assn.org

here are a few of the inherent risks that i foresee:
1. increased testing "to make sure everything is okay", including unnecessary testing
2. increased utilization of treatment such as antibiotics and medications
3. difficulty in maintaining a scientific nonbiased view of the patient and symptoms
4. difficulty in assessing effectiveness or lack thereof of treatment.
5. patient trust that might be unfounded or not understand that the aforementioned bias has occurred.
6. as a whole, unless you establish a true doctor-patient relationship, poorer monitoring and documentation of medical history.

i would also worry that the family member - if not an immediate family member - would hold resentment or tear at the family dynamics if things did not go as planned.
 
Baron Samedi said:
Wouldn't treat my spouse, would just offer to hold her hand during procedure.

Parents are the biggest nonlisteners of them all, lol.
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My parents listen better than my wife and slightly better than nurses, making them the 3rd worst listeners to my medical advice.
 
Ducttape said:
you answered the question yourself.

AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members

The AMA Code of Medical Ethics' opinion on physicians treating family members.
journalofethics.ama-assn.org journalofethics.ama-assn.org

here are a few of the inherent risks that i foresee:
1. increased testing "to make sure everything is okay", including unnecessary testing
2. increased utilization of treatment such as antibiotics and medications
3. difficulty in maintaining a scientific nonbiased view of the patient and symptoms
4. difficulty in assessing effectiveness or lack thereof of treatment.
5. patient trust that might be unfounded or not understand that the aforementioned bias has occurred.
6. as a whole, unless you establish a true doctor-patient relationship, poorer monitoring and documentation of medical history.

i would also worry that the family member - if not an immediate family member - would hold resentment or tear at the family dynamics if things did not go as planned.
Click to expand...


Straight from AMA, "It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available".

what you stated above just proves one point, you don't know how to remain objective when treating friends/family members. The key is to remain objective, then all your presumption (or shall I say "prejudice") makes no sense.

You should treat all your patients the same, not group them to friends, family members, class 1 patients, class 2 patients, etc. Your training should have taught you.

Sure, you can have concern your family members hold you resentment, so you can decide not to treat them. It's your prerogative to do so. But don't say because you don't want treat your members/friends or you believe you might not be objective, then you would label other physicians who do, as "unethical".

Have you ever been involved in your family members' healthcare? Have you ever taken your mom or your dad to a doctor's office? Have you ever been an advocate for your parents, spouse? If you haven't, you are lucky. Some of us don't have the luxury because we see the quality of healthcare in this country is going down the drain. Like I said before, who can take care of your loved ones better than yourself, if no good alternatives available?

Lastly, if you have the same mindset, let me ask you this question, who will be taking care of YOU when you are sick? because after all, you, as a physician can be biased when seeking healthcare. Another doctor/colleague of yours can refuse service to you for the same reason, because s/he can say it's impossible to remain "objective" because you guys know each professional or personally. Stupid argument, don't you agree? All in the name of remaining "objective".

Be careful of what you wish for. Treat others like how you'd wish to be treated.
 
Ducttape said:
you answered the question yourself.
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so you are saying to be a doctor is to not CARE? Somehow to CARE is equivalent to be non-Objective? You know some of us, despite of being doctors, deeply care about our family members and friends. To do so, we have to be EXTRA-objective and extraordinarily PROFESSIONAL to fend off prejudice like this.
 
drpainfree said:
Straight from AMA, "It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available".

what you stated above just proves one point, you don't know how to remain objective when treating friends/family members. The key is to remain objective, then all your presumption (or shall I say "prejudice") makes no sense.

You should treat all your patients the same, not group them to friends, family members, class 1 patients, class 2 patients, etc. Your training should have taught you.

Sure, you can have concern your family members hold you resentment, so you can decide not to treat them. It's your prerogative to do so. But don't say because you don't want treat your members/friends or you believe you might not be objective, then you would label other physicians who do, as "unethical".

Have you ever been involved in your family members' healthcare? Have you ever taken your mom or your dad to a doctor's office? Have you ever been an advocate for your parents, spouse? If you haven't, you are lucky. Some of us don't have the luxury because we see the quality of healthcare in this country is going down the drain. Like I said before, who can take care of your loved ones better than yourself, if no good alternatives available?

Lastly, if you have the same mindset, let me ask you this question, who will be taking care of YOU when you are sick? because after all, you, as a physician can be biased when seeking healthcare. Another doctor/colleague of yours can refuse service to you for the same reason, because s/he can say it's impossible to remain "objective" because you guys know each professional or personally. Stupid argument, don't you agree? All in the name of remaining "objective".

Be careful of what you wish for. Treat others like how you'd wish to be treated.
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all this you have posted is essentially a denial of one of our base mores. the fact that you agree to take on their care - excepting the situation where there is not the same specialist as yourself available locally - predetermines that you have not remained objective.


if you are truly introspective, you would realize that is exceedingly difficult to be truly objective to family. i doubt anyone on this forum, myself included, is so enlightened.



i am not smarter nor more knowledgeable than my parents internists, nor their neurologists, nor the surgeons and pain doctor that they saw. if there were medical decision that i disagreed with, i talked to the doctor myself with my parents permission.



your last point is just ludicrous. there is a clear distinction between giving medical treatment to a colleague or even a friend versus you treating a family member.
 
drpainfree said:
so you are saying to be a doctor is to not CARE? Somehow to CARE is equivalent to be non-Objective? You know some of us, despite of being doctors, deeply care about our family members and friends. To do so, we have to be EXTRA-objective and extraordinarily PROFESSIONAL to fend off prejudice like this.
Click to expand...
if you truly care about a family member, you should be involved in that family members care, not determining the treatment.

do you not see that your attempt to be extra objective, at a minimum, has already biased you and your medical opinion?
 
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