The Pitfalls of "Getting Involved"
Some physicians are reluctant to give impromptu medical advice for fear of potential lawsuits. While Dr. Jaffe admits she sometimes "uses the legal card as an excuse," practically speaking, few doctors face legal consequences from providing friends and family members with advice, says Robert Olick, JD, PhD, an Associate Professor of Bioethics and Humanities at SUNY Upstate Medical University. Although some friends and family might sue over "bad advice," most wouldn't dream of it. That said, Olick cautions physicians to make sure listeners comprehend the limitations of their relationship and their advice. You'll help ensure mutual understanding by adding caveats along the lines of, "I'm not your doctor and I haven't examined you, so I can only offer an educated guess," or "This isn't my area of expertise, and I recommend you talk to your doctor about this."
But lawsuits aren't the only pitfalls doctors should consider. When informally fielding questions, physicians need to be careful not to violate patient privacy. They also need to understand that what may begin as a small request can lead to more intense involvement and situations that can be inconvenient and damaging to the relationship.
Here's an example: One gastroenterologist (who requested to remain anonymous) remembers when a family member asked for his help in securing an appointment with a sought-after specialist for her adult son. He obliged by setting up the appointment, only to discover the son didn't want to see the specialist and resented his mother's involvement. "I made a false assumption that the son wanted the appointment," the doctor recalls, "and then I felt silly in the eyes of my colleague. I couldn't help wondering what he must have thought about me. It was embarrassing."
On another occasion, a professional acquaintance asked the gastroenterologist to recommend a primary care physician. He happily passed along the name of a highly qualified doctor. A week later, the same person called, inquiring about a specialist for his wife. Then came a third call and a third request. "I began to feel a little bit used," the doctor recalls. "I was functioning as a primary care physician who was connecting these individuals with specialists, and that was something I really shouldn't have been doing."
Play It Straight Down the Middle
Of course, as the AMA guidelines suggest, the greatest danger of helping out a friend or a family member is that it might impair a physician's judgment or color the nature of the relationship, or the interaction might result in bad medical decisions, says Arthur Caplan, PhD, Director of the Division of Medical Ethics at NYU Langone Medical Center in New York.
"When somebody asks you about a rash at a party, you're not in a diagnostic mode," Caplan says. "You don't say, 'Take off your shirt; I want to see what else you've got.'" It's not wrong for physicians to want to help, he says, but they have to be constantly mindful of what they don't know about a situation. "Never leave a person with the feeling that you've settled the problem simply because you spoke with them at a party or a picnic."
Friends and family members aren't inherently wrong to seek your advice, of course. You're a trusted source, and they're faced with a baffling array of questions. As complex -- and often conflicting -- information propagates the Internet, it's no surprise that they ask for help in deciding what to believe. And as deductibles and copays skyrocket, it's understandable that they seek your opinion before rushing off to their own doctors.
Questions are appropriate and to be expected, Caplan says, but doctors have to wrestle with themselves in determining how to respond if they're to act responsibly and ethically. "When close friends and family ask for medical advice, that's always a matter for introspection, and at the end of the day, it's not resolved by codes of ethics but by considered individual judgments."
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Cite this: The Pitfalls of Giving Free Advice to Family and Friends - Medscape - Apr 10, 2014.
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