COMMENTARY

Family as Patient: Yes, No, or It Depends?

Brandon Cohen

Disclosures

June 15, 2015

A colleague tried the direct approach:

My standard reply during a [social] gathering is a simple: "Please let me relax—I'm off duty," whenever someone comes up with a request for advice.

Another primary care physician tried both evasion and wry humor to avoid treating an acquaintance:

I remember an incident at a party several years ago. A man kept following me around asking about elbow pain when he played golf. After unsuccessfully avoiding him and his questions, I gave him an answer. I told him he would just have to stop playing golf.

An emergency department physician regretted help given out for free:

I cleaned out a nasty wound and prescribed some Augmentin® for my landscaper when a neighborhood dog bit him. He was very gracious and thanked me profusely, saying how much a trip to the ER would have cost him out of pocket. Weeks later he billed me full charge for some mulch and yard work... Does a plumber unclog your pipes for free? Does an electrician do your wiring out of the goodness of his heart?

But many doctors were equivocal. A conflicted surgeon wrote, "One cannot deny outright the request; at the same time, one should somehow wriggle out without hurting them."

A neurologist advised colleagues to simply proceed with care: "I will give very cautious advice, usually very generic, or make recommendations about who I trust to see."

A urologist concurred and went into greater detail:

After 45 years of practicing medicine, here a few tips: know your boundaries and limitation; do no harm; do not assume; always say... "The advice I give you is incomplete and limited."... If they insist, offer your official service by requesting politely: I will be glad to see you in the office if you so wish.

And a neurologist tried to see all sides:

If advice to friends and family causes harm, then it has negative implications. On the other hand, if advice prevents harm, or leads to a more optimal outcome, then it has positive implications. It's like everything else in life; you win some and you lose some.

The final word goes to a surgeon, who summed up one important aspect of this dilemma succinctly, "I suppose one needs to choose your friends wisely. But with family, I guess there is no choice."

The complete versions of these two discussions are available online: Giving medical advice to friends and family and The Pitfalls of Giving Free Advice to Family and Friends

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