COMMENTARY

Why Can't You Be Friends With Your Patients?

Arthur L. Caplan, PhD

Disclosures

October 08, 2013

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Hi. I'm Art Caplan from the Division of Medical Ethics at the NYU Langone Medical Center. Should you be socially friendly with your patients? We all know what certain rules are. You're not supposed to have romantic relationships. You're not supposed to date someone who is in your care.

But recently at the Michael Jackson trial, information came out that many of the doctors he had hired were not just taking care of him; they were hanging out with him. They'd go golfing and go to concerts. They would watch television with him. They became his friends. Is that ethically correct?

I think that when many physicians hear about people getting friendly with patients, the initial reaction is that it can't be right. It's not the right thing to do. It could distort your judgment. It could make you reluctant to bring up certain things with a patient whom you view as a friend. The friendship relationship makes it difficult to do.

However, I have been around in enough places to see that, in many contexts, physicians do wind up being friends with their patients. If you are in a small town and you're the only primary care physician there, you are going to see your patients when you go to the PTA. You're going to see them when you go golfing or to a club. You're going to see them if you go bowling. In the ordinary course of events, you are going to run into these people, and some of them are going to become your friends.

So I think the answer to the question is yes, you can befriend a patient, but with a couple of qualifications. The friendship should never distort your judgment. If you feel reluctant to bring up an issue with someone because he is your friend, that friendship has to end or the friend needs to see another physician, and you could make that recommendation.

If someone is your friend and also your patient, you have to be extraordinarily sensitive in assuring him that you are going to keep his privacy and confidentiality, explicitly addressing the fact that you are friends. "You can tell me what you need to tell me. I'm going to look out for your privacy first and I'm not going to gossip. I'm not going to tattle on you or reveal any truths." That is essential to the best type of medical care.

It goes without saying that if you befriend a patient, it doesn't mean that you're going to push it to the limit. It's one thing to have social relationships that evolve naturally, but it's a different thing to say, "I'm going to take advantage of my position as a doctor and a respected person in town to try to force people to be friendly with me." Friendship has to occur as a natural social emotion. It's not something that should be there because someone thinks that you won't be his doctor or that you're not going to pay attention to him unless he forms some kind of relationship outside the office.

Friendship is something that we admire. We think it's a good thing. In the real world of human beings, friendships are sometimes going to form between doctors and their patients. You just have to be sensitive to the fact that ethically, as soon as that friendship starts to distort the practice, the friendship has to end.

I'm Art Caplan from NYU. Thanks for watching.

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