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Assess

 Patient: Autonomy

 Practitioner: Beneficence & Nonmaleficence

 Public Policy: Justice

Conclude

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46. Self & Family Treatment


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A medical practitioner who treats oneself has a fool for a doctor and a fool for a patient.
~ William Osler

Abstract

The medical practice of treating oneself, family members, or friends is discouraged due to lack of professional objectivity and violation of patient autonomy. Treating family members or friends can lead to a compromised patient-practitioner relationship, causing issues with confidentiality, informed consent, and intimate examinations. The medical practitioner’s role of maximizing the patient’s best interests, as well as upholding the principles of beneficence (do good) and nonmaleficence (do no harm), is threatened by the conflict of interest present when treating family or friends. This practice also violates the patient’s positive right to a fair and impartial practitioner and is categorized as unprofessional and a potential form of medical misconduct. Exceptions to these practices for medical emergencies can be made but should be uncommon and not lead to an unacceptable standard. The American Medical Association (AMA) Code of Medical Ethics Opinion 1.2.1 states:

Physicians [Medical practitioners] should not treat themselves or members of their own families.

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Think 

[46:1] Medical practitioners are not to treat, oneself, family members, or friends because of the lack of professional objectivity that may influence their medical judgments, such as medical denial or attempting to self-treat ailments beyond the practitioner’s professional expertise. When a practitioner treats a family member or friend, the “patient” may be uncomfortable and unwilling to openly disclose relevant information which might be necessary for appropriate diagnosis and treatment options because it would be too embarrassing to disclose, as well as a violation of the right to privacy. The practitioner may also be uncomfortable and unwilling to conduct a necessary intimate physical examination because it would be inappropriate to do so with that type of relationship. The treating of family members and friends can also have a negative social impact of inadvertently causing changes in role responsibilities and upending social hierarchies in the family structure or friendship. Practitioners are not to self-treat because of the lack of professional objectivity that may negatively influence their medical judgment. These are a few of the consequential negative reasons why practicing medicine on oneself, family members, and friends is against medical standards of care. This prohibition is based on the patient-practitioner relationship that can be significantly compromised when treating oneself, family members, and friends. 

[46:2] The American Medical Association (AMA) Code of Medical Ethics Opinion 1.2.1 states:

Treating oneself or a member of one’s own family poses several challenges for physicians [practitioners], including concerns about professional objectivity, patient autonomy, and informed consent. … When the patient is an immediate family member, the physician’s [practitioner’s] personal feelings may unduly influence [their] professional medical judgment. … They may also be inclined to treat problems that are beyond their expertise or training. … In general, physicians [practitioners] should not treat themselves or members of their own families.

Assess
Patient: 1) Autonomy

[46:3] Patient autonomy requires the necessary conditions of confidentiality and privacy that are part of the patient-practitioner relationship. When a medical practitioner treats a family member or friend, confidentiality and privacy are at high risk of being violated. If the practitioner is socially sensitive with self-awareness, then the practitioner may avoid asking embarrassing and sensitive questions, and the practitioner will avoid performing intimate physical examinations. When treating family members and friends, the patient-practitioner relationship that is so essential for the practice of medicine is threatened as either not existing, or if it does exist, it becomes a conflict of interest between the role of the medical practitioner and the role of being a family member or friend.

[46:4] If there is no patient-practitioner relationship, then it will be impossible for the patient to provide autonomous informed consent, as the practitioner’s diagnosis, prognosis, treatment options, and risk-benefit assessments will be compromised due to the lack of truthful patient communications, the inappropriateness of the practitioner to conduct intimate physical examinations, and compromised medical judgments due to emotional and other sociological factors.

[46:5] Patients have a positive right; to medical access, to qualified practitioners, and to form a patient-practitioner relationship necessary for autonomous informed consent decisions.

Practitioner: 2) Beneficence & 3) Nonmaleficence

[46:6] The medical practitioner’s professional role is to maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. With the practitioner treating oneself, family, or friends, it is easy for the practitioner to be self-deceived into thinking that they are in the best position to make such assessments because of the close personal relationship and knowledge of the patient’s reasonable goals, values, and priorities. However, if the treating of family members and friends results in a violation of patient autonomy, because of a variety of conflict of interest, then this can result in the violation of the professional obligation of beneficence (do good) and nonmaleficence (do no harm). Therefore the medical profession has categorized self-treatment, family-treatment, and friend-treatment as unprofessional and a potential form of medical misconduct.

Public Policy: 4) Justice

[46:7] The treatment of self, family members, and friends violates the citizens’ positive right to have access to a fair and impartial practitioner. The medical practitioner’s treatment of self, family members, and friends violates that positive right.

[46:8] Certainly, exceptions can be made in situations of a medical emergency, minor and commonplace conditions, and those situations independent of the necessity of having a patient-practitioner relationship. However, judgments regarding the exceptions to the medical standards of care must not become the accepted standard.

Conclude

[46:9] Making medical decisions as a practitioner for oneself, family members, and friends violates patient autonomy, as there is a conflict of interest between the role of the practitioner, and the role of being a family member or friend, a violation of the professional obligation of beneficence (do good) and nonmaleficence (do no harm) It is a violation of medical standards of care and the patient’s civil rights for access to a fair and impartial practitioner. Exceptions to these practices for medical emergencies and care independent of the patient-practitioner relationship should be uncommon, and not lead to an unacceptable new standard.

[46:10] The American Medical Association (AMA) Code of Medical Ethics Opinion 1.2.1 states:

Physicians [Medical practitioners] should not treat themselves or members of their own families.

[46:11] In summary, medical practitioners should avoid treating themselves, family members, or friends to maintain the integrity of the patient-practitioner relationship and uphold the principles of patient autonomy, beneficence, and nonmaleficence. By adhering to this standard of care, practitioners can protect both their patients’ rights and their professional responsibilities. The American Medical Association (AMA) Code of Medical Ethics Opinion 1.2.1 serves as a reminder that physicians should not treat themselves or members of their own families in order to maintain the highest level of ethical and professional conduct.

(For more information on professional boundaries, see: 3. Addressing oneself & One’s Patient, 47. Sexual Boundaries, and 48. Social Media Boundaries)

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46. Review Questions

1. Practicing medicine on oneself, family members, and friends is not against medical standards of care and does not compromise the patient-practitioner relationship.

2. Patients have a positive right to medical access to qualified practitioners to form a patient-practitioner relationship necessary for autonomous informed consent decisions.

3. If the treating of family members and friends results in a violation of patient autonomy because of a variety of conflict of interest, then this may result in the violation of the professional obligation of beneficence (do good) and nonmaleficence (do no harm).

4. The treatment of self, family members, and friends violates the citizens’ positive right to have access to a fair and impartial practitioner.

5. Exceptions to the treatment of self, family members, and friends can be made in situations of a medical emergency, minor and commonplace conditions, or those situations independent of the necessity of having a patient-practitioner relationship.

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46. Clinical Vignettes

1. Dr. James Lee, a 50-year-old cardiologist, has a sister who presents to his clinic with a complaint of chest pain and shortness of breath. Dr. Lee is faced with an ethical dilemma regarding whether it is appropriate to treat his sister as a patient.

2. Ms. Samantha Wilson, a 35-year-old pharmacist, presents to the pharmacy with a complaint of a persistent cough and sore throat. She informs her colleagues that she has diagnosed herself with a viral infection and has started taking an over-the-counter medication without a prescription. An ethical question arises regarding whether it is appropriate for healthcare providers to treat themselves.

3. Dr. Jessica Hall, a 30-year-old practitioner, is on a family vacation when her father suddenly experiences chest pain and shortness of breath. As a practitioner, she is faced with a dilemma regarding whether it is appropriate to provide medical care for her father.

4. Dr. David Clark, a 50-year-old psychiatrist, is at a family gathering when his cousin approaches him and requests a prescription for an antidepressant. The cousin explains that he has been feeling down and has read online that a specific antidepressant would be helpful for his symptoms. An ethical question arises regarding whether it is appropriate for healthcare providers to treat their family members and friends with prescription medications.

5. Ms. Maria Hernandez, a 35-year-old unemployed mother of two, visits the clinic with symptoms of depression, including sadness, loss of appetite, and difficulty sleeping. She is a close friend of the medical practitioner. The clinical differential diagnosis includes major depressive disorder, adjustment disorder, and dysthymia. As a medical practitioner, what is the ethical course of action in this situation?

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46. Reflective Vignettes

1. Dr. Jane Smith, a 35-year-old family medicine practitioner, encounters a family member seeking her medical expertise for a school physical and a urinary tract infection. However, Dr. Smith is aware that treating family members and friends is discouraged due to a lack of professional objectivity and the potential violation of patient autonomy. Dr. Smith also knows that treating family members and friends can lead to a compromised patient-practitioner relationship, causing issues with confidentiality, informed consent, and intimate examinations. Furthermore, the medical practitioner's role of maximizing the patient's best interests, as well as upholding the principles of beneficence and nonmaleficence, is threatened by the conflict of interest present when treating family or friends. Despite the familial relationship, Dr. Smith cannot provide treatment and must refer the family member to another medical practitioner to ensure proper patient care, maintain professional objectivity, and uphold medical standards of care.A practitioner is approached by a family member for getting a school physical and treatment for a urinary tract infection.

Think

Assess

  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice

Conclude

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2. Ms. Jane Doe, a 45-year-old physician, has been experiencing symptoms of a chronic disease for the past few months. Due to her concerns about confidentiality and privacy in the workplace and fear of being considered less competent, she has decided to self-treat her condition. Despite her medical training, she recognizes the potential dangers of self-treatment and the risk of making incorrect medical decisions. She is torn between her desire for privacy and the need to receive proper medical care. The differential diagnosis for her symptoms includes several possible chronic conditions, such as diabetes, hypertension, or autoimmune disorders.

The practitioner should not self-treat a chronic disease, as it violates medical standards of care. Instead, the practitioner should seek medical treatment from a qualified medical practitioner who can maintain confidentiality and provide an objective medical judgment. The practitioner should also address their concerns about confidentiality and privacy in the workplace with their employer or supervisor and seek appropriate solutions. Fear of being considered less competent should not be a factor in the decision to seek medical treatment and should be addressed separately through self-reflection and potentially seeking support from a mental health professional.
Think

Assess

  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice

Conclude

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3. A seasoned faculty member at a well-respected medical school was speaking with a junior colleague. In this conversation, the young medical practitioner said they “won’t allow” their parents to be vaccinated because a well-known cardiologist said that there was an increased risk of myocarditis or pericarditis associated with being vaccinated. The young practitioner readily admitted that they and their three offsprings were fully vaccinated with all the “usual” vaccines.

The seasoned faculty member should address the junior colleague by expressing concern about their decision not to vaccinate their parents and highlighting the importance of evidence-based medicine in decision-making. The faculty member can explain that while it is understandable to be cautious and seek advice from respected experts, it is essential to critically evaluate the evidence and consider the potential benefits and risks of vaccination. Additionally, the faculty member can offer to provide resources and support to help the junior colleague make an informed decision for their family members' health.

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46c*

A seasoned faculty member at a well-respected medical school was speaking with a junior colleague. In this conversation, the young practitioner said they “won’t allow” their parents to be vaccinated because a well-known cardiologist said that there was an increased risk of myocarditis or pericarditis associated with being vaccinated. The young practitioner readily admitted that they and their three offsprings were fully vaccinated with all the “usual” vaccines.

Think

Assess

  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice

Conclude

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