Hey, Doc, Do You Mind if I Ask You...?
Given the breadth of questions friends and family may ask, doctors simply can't respond with a stock response, says Gregory Eastwood, MD, interim President of SUNY Upstate Medical University, in Syracuse, New York. Rather, you need to be thoughtful and prepared. "This whole area of giving incidental advice can easily escalate," he says. "There's not a clean line between answering a question or giving a piece of advice and taking care of somebody and taking responsibility for their care."
While most doctors are wary of friends' and family members' requests for prescriptions, they may be less attuned to the dangers posed by providing advice. Physicians need to know when "helping out" approaches the point of duty of care, Dr. Eastwood says, which could establish a physician-patient relationship with all of the legal and ethical obligations that go along with it.
Michelle Berger, MD, an Austin, Texas-based ophthalmologist, says friends, family, and casual acquaintances typically ask for her medical advice or help 2 or 3 times a month. "You're out socially or at a party, and if people find out you're a physician, they have questions."
People don't understand the implications of their requests, she says. She recalls one mother who texted her pictures of her son's black eye and couldn't appreciate why Dr. Berger said she couldn't diagnose the child's injury without examining him. Friends are often equally befuddled when she refuses to write them an "emergency" prescription because they've run out of contact lenses. "They don't understand what the laws are. In our state you have to have an exam and a chart in the office and an established physician-patient relationship."
Dealing with out-of-town family members can be particularly challenging, she says. When a relative recently called about a problem another family member was experiencing, Dr. Berger had to explain that without examining the woman, she couldn't diagnose or treat the problem. "I tell them, 'I wouldn't want to do any harm,'" she says. "Most people understand and accept that. You have to be as polite as you can, but you have to know what your personal boundaries are and where you can go and where you can't."
Digging Yourself Into a Hole
Rebecca Jaffe, MD, a Delaware family practitioner, views the matter in practical terms: While answering a quick initial question might be okay, the chances that it will require follow-up questions and information means a simple request from a friend or family member is likely to snowball. "When family and friends come to you, it's usually because they trust your opinion and your ability to navigate this very complex medical system," she says. "There are times I wish I could offer more help, but once you put both feet in the water, it's hard to get yourself out." Instead, she routinely directs advice-seekers to 2 or 3 reliable sources for medical information.
Taking such an arms-length stance can be helpful in some cases, Dr. Jaffe says. "I've had neighbors who say, 'My kid sprained her ankle in a soccer match. Should I go to the clinic or wait it out?' I tell them, 'You're going to need to use your own common sense.' Sometimes -- especially in the case of a nonrelative -- that works very well because they don't call a second or third time."
Nevertheless, politely dealing with a neighbor's medical request might be a lot easier than brushing off a family member's. "I try not to give too much medical advice, even to my parents," Dr. Jaffe says. "I see my role as an advocate: to help them synthesize information when they have questions. When my mother calls and says, 'I'm short of breath and I don't know what to do,' I walk her through all the things her doctor has talked to her about: Have you taken your blood pressure and pulse? Do you know how many times you're breathing per minute?
"I'm only reminding her to do what her doctor said, but he said it very quickly along with a lot of other information. By repeating those questions, it helps her distill the information. If she has questions beyond that, I tell her, 'Mom, it's time to call your doctor.'"
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Cite this: The Pitfalls of Giving Free Advice to Family and Friends - Medscape - Apr 10, 2014.