Procedure on Family

[pmrmd]

In the pain world these questions aren’t difficult to answer for anyone here. Treat your family member if they ask. If you are a competent physician do what you do.

Manufacturing an ethical debate when the treatment algorithms are generally set makes no sense. We aren’t making life and death decisions.

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[drpainfree]

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.

if you don't think you know more about your parents' or your spouse's PAIN MANAGEMENT problem than their pain management doctor (assuming they have one), it says either one of two things: you really don't care your about parents or spouse health conditions in general and pain problems specifically and to be thoroughly objective to be a good pain doctor for your loved ones, or you just don't care about patients in general. I don't disagree with you you don't know much about endo/immunology, or any other specialist in the respective fields, but I know plenty of pain management physicians treating their family members or friends for pain management issues.

again, If you treat every patient exactly the same by formalizing your medical records and remain objective and thorough in the treatment process, you have no reason to treat anyone differently.

 

[drpainfree]

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?

It's my job to remain objective, not something you can determine in a blanket statement preemptively.

What if your determination of best course of treatment is better than the care offered by an alternative?

Let's say, you know your mom clearly has facetogenic LBP and needs diagnostic medial nerve branch block, possible RFA. When she goes to see the only orthopod in her network referred by her PCP the orthopod insists on an epidural without talking to her for more than 5 minutes.

You didn't answer my question. let me ask you again, specifically, within last 5 years, how many times have you taken your mother, father, wife, kids to doctor's office for medical care? If you haven't, I don't think we're on the same page discussing this topic. You are living a fantasy world of your own "ethics bubble" when everyone else has to deal with real world problem. As a physician in pain medicine, particularly in chronic pain, I would love to help my patients, regardless he/she's my family members and friends, or not.

If you have problem remaining objective and treating every patient the same, it's your problem

Get off your high horse, and mind your own business.

 

[drpainfree]

In the pain world these questions aren’t difficult to answer for anyone here. Treat your family member if they ask. If you are a competent physician do what you do.

Manufacturing an ethical debate when the treatment algorithms are generally set makes no sense. We aren’t making life and death decisions.

completely agree. as an anesthesiologist, I would think twice about doing CABG for my mom, not because whether or I can be objective, but more because the risk involved and there are good alternative with more experience in cardiac anesthesia that I do. On the other hand, if my wife needs a MAC for endoscopy and the only alternative in ASC is a guy who just came out from residency training and every nurse is talking bad about this new guy, yeah, I would be happy to provide the care to my wife, objectively and professionally without compromising standard of care.

Decisions like this is a realistic one we all have to weigh against, risk, benefit, and alternative. This manufactured argument on "ethical" is just nonsense.

It's like you have a kid in a public school that's failing their students, AND your wife is a teacher with 20 years of experience, you tell your wife it's "unethical" for her to teach her own kid, because you think your wife couldn't be "objective".

 

[Ducttape]

if you don't think you know more about your parents' or your spouse's PAIN MANAGEMENT problem than their pain management doctor (assuming they have one), it says either one of two things: you really don't care your about parents or spouse health conditions in general and pain problems specifically and to be thoroughly objective to be a good pain doctor for your loved ones, or you just don't care about patients in general. I don't disagree with you you don't know much about endo/immunology, or any other specialist in the respective fields, but I know plenty of pain management physicians treating their family members or friends for pain management issues.

again, If you treat every patient exactly the same by formalizing your medical records and remain objective and thorough in the treatment process, you have no reason to treat anyone differently.

thats idiotic and honestly hubris to think that you can treat your parents objectively

the fact you are seeing your own parents means you have lost objectivity. the fact that you so vehemently defend pain doctors treating their family members points out the same. emergency settings....


when treating your parents, do you:
1. do a standard physical examination and dictate thorough notes in the EHR
2. schedule a new patient appointment and follow up appointments to be done in your office during regular business hours
3. bill your parents co pays and deductibles
4. go through the same prior authorization process as all of your other patients
5. tell them "sorry your insurance denied that procedure, i cant do it for you" if that happens


children under a certain age have an added layer of complexity, inasmuch as there is the concern that you may be seen as coercing treatment


with regards to your second post, i did state that there will be times in which it is unavoidable. you posit a possible situation, although a tenuous one, where it may be ethically better to provide care than to have it withheld.


and just because other doctors are doing it doesnt make it right for everyone to do it. argument ad populum

 

[drpainfree]

thats idiotic and honestly hubris to think that you can treat your parents objectively

the fact you are seeing your own parents means you have lost objectivity. the fact that you so vehemently defend pain doctors treating their family members points out the same. emergency settings....


when treating your parents, do you:
1. do a standard physical examination and dictate thorough notes in the EHR

YES

2. schedule a new patient appointment and follow up appointments to be done in your office during regular business hours

YES

3. bill your parents co pays and deductibles

YES

4. go through the same prior authorization process as all of your other patients

YES

5. tell them "sorry your insurance denied that procedure, i cant do it for you" if that happens

YES

Do I need to teach you how to be objective and professional?

How many times do I have to tell you you have to treat all your patients the same, regardless their relationship to you.

 

[Ducttape]

i would argue that if you are doing exactly that, you are the 1 out of about 100 pain doctors who are treating their family member in an objective manner. in every situation that i have heard involving other doctors treating their family members, they did not do this.


i still hold my reservations that this is your exact practice, and that you do not ever mention their pain, say, over family dinner, or on the phone while chatting.


but if you are, kudos to you.


and if you are, how do you convince your family member that they have to wait to discuss their pain or treatment until their next appointment in the office in 6 weeks...

 

[drpainfree]

i would argue that if you are doing exactly that, you are the 1 out of about 100 pain doctors who are treating their family member in an objective manner. in every situation that i have heard involving other doctors treating their family members, they did not do this.


i still hold my reservations that this is your exact practice, and that you do not ever mention their pain, say, over family dinner, or on the phone while chatting.


but if you are, kudos to you.


and if you are, how do you convince your family member that they have to wait to discuss their pain or treatment until their next appointment in the office in 6 weeks...

If I have any family members, friends or even staff member who want to have me as their pain management physician, I first thank them for trusting their care to me. I then schedule them to my office visits, like how I would schedule any other patient. Even for my staff, I do EXACTLY the same.

I work on quality, not volume. I make sure my patients don't have to wait more than 2-4 weeks to see me. Otherwise, how do I treat my patients like they are my friends? If I cannot feel these are my friends I'm treating, why am I doing what I'm doing if there's no joy?

 

[lobelsteve]

It’s not like I can trust any of you yahoos to do a kyphoplasty on my mom.