Unethical to treat family members?

[wcbcruzer]

During my interview a few days ago, we were just talking about why I wanted to be a doctor. I was speaking honostly and comfortably. One of the things I said towards the end was how I like the idea that I could treat family and friends as a doctor. Then the interviewer said that that's a bit unethical. I was like... "Really?" Maybe he misunderstood me but how is it unethical if family members come to you with a problem?

Then I said: "Well I mean, if they have a problem they can ask me questions." Then he nodded his head in agreement (unless he was faking it).

Any idea why he said that? Or maybe how he understood me?

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[futuredo32]

As a physician, you need to be objective and this could be difficult when treating relatives.

 

[fireflygirl]

I guess I can kind of see how it could be considered unethical. My father is a physician and I can see how he can sometimes lose his sense of objectivity with his family when treating them. Once, I was severely dehydrated from food poisoning and he was trying to get an IV started but my condition was deterioting pretty rapidly and it was becoming harder to find a vein and causing me more pain and he was getting nervous about all types of other things that were going wrong. Eventually he just had me admitted. It's a minor example but it shows that as a parent or family member it can be hard to keep your mind on the medical issue at hand and it's easy to lose your objectivity when your feelings can get in the way. And if that leads to endangering the patient, then I can see how that could be unethical but I am not sure that the interviewer used the most appropriate word in that conversation. Most times, I don't think treating family members leads to that and if the family member does have a serious condition that the physician just can't treat due to specialty or inability to personal relations and emoitions at bay, then I would hope that the physician would be responsible enough to seek out help from another physician.

 

[spicedmanna]

During my interview a few days ago, we were just talking about why I wanted to be a doctor. I was speaking honostly and comfortably. One of the things I said towards the end was how I like the idea that I could treat family and friends as a doctor. Then the interviewer said that that's a bit unethical. I was like... "Really?" Maybe he misunderstood me but how is it unethical if family members come to you with a problem?

Then I said: "Well I mean if they have a problem they can ask me questions."

Any idea why he said that? Or maybe how he understood me?

Well, I'd argue that it isn't really unethical (in the "black or white" ethical/unethical sense) to treat family members, per se, but it is potentially problematic, and if there are other options, it would be wise to consider them. We don't live in a black and white world, so it is a matter of decision between a spectra of choices, if the situation isn't so clear cut and other choices are available and accessible. What we are then looking for is the most ethical option.

If we use the Beauchamp-Childress bioethics model (Principles of Biomedical Ethics) of "automony, justice, beneficance, and non-maleficence," as ethical reasoning criteria between options, where the idea of treating close family members comes into question is with the principles of patient autonomy and justice. Indeed in the hope of providing beneficant treatment of their family members, physicians could pit that principle against the need, or ability, of the patient to be autonomous (informed consent, voluntariness, etc.) and also place into question his or her own ability to act in a manner that is fair and objective. The need to be beneficant to family members can thus be overriding, compromising on the ability of the physician to render care to him or her. Therefore, a better and arguably more ethical choice, if these dynamics come into play, would be to refer the close family member to another qualified physician to manage his or her care, who can potentially better fulfill the criteria and care for them.

Just my 2 cents.

 

[wcbcruzer]

Well thanks for the responses. I was kinda shocked when he said it was unethical. I couldn't see any reason why it would be, but the reasons you brought up make sense.

 

[McDoctor]

"Unethical" is too strong a word. this is a gray area and exists on a continuum. You would have to be some kind of jackass to not occasionally prescribe 3 days of bactrim for a UTI or albuterol for intermittent asthma, should the need arise on a saturday evening. This convenience is partly why your spouse married you as a doctor. But if your significant other thinks he/she "might have ADHD" and wants high doses of amphetamines, maybe you better punt to a more objective opinion. There is a ton of gray area in between.

"That can be a bit uncomfortable and irritating..." is what it eventually becomes, and would have been a more accurate response from the interviewer, not "unethical". Usually, you'll want to punch out at the end of the day and not be bothered about your father-in-laws prostate problems.

 

[wcbcruzer]

Bactrim! That's the one drug I've always been told I'm allergic too.

Wait, so you're saying you CAN'T prescribe coke to friends who have minor headaches?