I believe all medical doctors, even as medical students, are asked questions regarding the different illnesses and treatment regimes that family members or close friends (sometimes even distant ones) suffer from or are subjected to. I’ve always felt a certain pride in being able to answer these questions, but with increasing seniority (although I would still call myself very junior in career terms) I’ve gotten increasingly careful with my so-called consultations during my free-time.
This change in attitude is not due to the lack of knowledge or willingness to help – quite the opposite. I’ve seen several cases in my own everyday practice where the good intentions of family members with medical knowledge is the root of the problems at hand. This is, I believe, due to a multitude of unfortunate factors that together produce a mess that is manageable at best and lethal at worst. There is a distinction to be made between being the first-hand care provider or a “second opinion” on provided care. For the sake of this essay, I will focus solely on the former.
First of all, I will not be able to subjectively and honestly assess the case when presented by a family member. As much as I like to pride myself in being able to maintain a proper professional relationship to my patients, while at the same time not becoming distant, this simply doesn’t work when the subject is a relative or close friend. Why, one might ask? In my mind, the answer is very simple: because we care about the person to the extent where our minds don’t want them to fall ill or be at risk of death, which inevitably introduces a very dangerous ingredient in the cocktail that is a medical consultancy: bias. Bias regarding the severity of disease, bias regarding the possible differential diagnoses, bias regarding treatment alternatives and bias regarding prognosis.
Secondly, the relationship between me and the imaginative subject is also influenced by the other person’s unwillingness to cause me pain, making them likely to report symptoms in a skewed way, making me even more prone to not be able to come to a truthful conclusion regarding their physiological state.
Thirdly: all medical doctors have their personal little graveyard, filled with dead patients who were subject to their poor judgment or inability to provide necessary care in due time. These people already sit at the back of the mind of the doctor, and in some cases haunt doctors for years – and these people were strangers to us. The prospect of filling my own graveyard with people I love is unbearable, and not something I would be prepared to do for the sake of my own mental health.
In medicine, we’re taught not to harm. One of my teachers in medical school, an oncologist, once said that a doctor “never harms, rarely cures, often relieves and always consoles”. Similarly, in medical ethics, we’re guided by four main pillars: beneficence (doing good), non-maleficence (not harming), autonomy (of patients, to choose their path forward in an informed way to the highest extent possible) and justice. I think that providing first-hand care to your relatives risks breaking all of these for pillars: we are, in fact, not doing good as we will struggle to make good clinical decisions. Furthermore, we risk harming our relatives and their autonomy will not be properly advocated for as they trust you and risk doing something they don’t want to because you said so. Finally, from the perspective of public interest, it is not fair neither to the relative to receive bad care, nor to the general public not to have access to a phone-doctor.
As you might have already concluded, I’m against being the main provider of medical care for people in my close proximity. This doesn’t mean I’m not willing to give opinions or consider the treatment that others are providing in the case you’re presenting with – it simply means that I’m not prepared to be the main provider. Nor does it mean that I’m not going to be there to support you when you fall ill – but I’ll be there as a relative who happens to have medical knowledge instead of being there as a medical doctor who happens to be a relative.
What do you think about doctors providing first-hand care to their relatives? Let me know!
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