Endless Requests for Free Medical Advice
As every doctor knows, requests for medical advice don't end when a doctor leaves the office for the day. They are made in parking lots and supermarkets, on buses and planes, at weddings and funerals.
"I'm a doctor 24/7," says Sandra Adamson Fryhofer, an internist in Atlanta, Georgia. "When you're a doctor, you're never off-duty." Dr Fryhofer isn't exaggerating.
Take Gregory Lawton, MD, a pediatrician in Chalfont, Pennsylvania. Dr Lawton might be sitting in the bleachers watching his son play soccer. Or he might be leaving a Bible study group. Regardless of the situation, it is not unusual for him to be approached by a concerned parent. "My kid is snoring," the parent will confide to him. Or, "He's wetting the bed, and he's 7 years old." Or, "We found a letter from our daughter that contained disturbing stuff. Is this normal? Do you think we should speak to a pediatrician? Do we need to see a therapist?"
"It's about the kid, but it's not, 'Look at my kid.'" Dr Lawton reflects. "It's just, 'What do you think? I know you see a whole bunch of kids, and is your sense that this is something we should pursue?'"
"I frequently get asked about medical conditions," says Harvey Hsu, MD, medical director of the Banner-University Medical Center Internal Medicine Clinic in Phoenix, Arizona. "With family, I have been asked about skin lesions, rashes, and even a breast lump, which actually turned out to be breast cancer. With staff in the office, I get asked about rashes, ear pain, and sore throat."
Dr Hsu has also talked with family friends on the phone about their medical problems. He has given second opinions as well.
Being Helpful Without Actually Giving Advice
Inevitably, there are times when a doctor doesn't want to, shouldn't, or can't offer free medical advice. But it isn't always easy to avoid doing this, particularly when the person who is making the request is a friend or relative.
Risk management consultant Lee Johnson, JD, offers one way out of this dilemma. "A doctor and a lawyer are playing golf," she says. "The doctor complains about all the free medical advice he is always dispensing to friends and acquaintances at social gatherings. The lawyer says he has a solution: He tells the person he is with what his rate is, and usually they just drop it. A week later, the doctor gets a letter from the lawyer. His bill is enclosed."
Palliative care specialist Erik K. Fromme, MD, associate professor of medicine at Oregon Health Sciences University in Portland, devised a thought-provoking case study in the AMA Journal of Ethics. The issue: treating family members.
Martha was at her cousin's for a family dinner when she was approached by her Uncle John, who had practically raised her from childhood and had loaned her money to pay for medical school. He had had a terrible cough for weeks and was feeling quite ill. His doctor couldn't fit him in until next month. Could Martha give him a quick look?
"I'd love to take a look, but I really shouldn't," Martha replied. "I think you'd do better to go see someone else. Maybe there's someone else in your doctor's practice who can see you on short notice? Or the walk-in clinic on Water and Main, if no one at the regular practice can see you and things keep getting worse. I'm sorry, but—do you think that would be all right?"
Uncle John looked hurt and avoided her for the rest of the evening.
Although Martha did the right thing from a professional standpoint, Dr Fromme comments, her justification was kind of lame. She could have examined her uncle, and even written a prescription for antibiotics for him, without breaking the law. (This might not have been true if the script had been for a cough medicine containing a controlled substance. State laws differ.) However, professional practice would have dictated performing a physical exam on her uncle and documenting the encounter in a medical record, the same as with any patient.
But this still leaves an ethical problem: Doctors are not supposed to treat family members, because their objectivity may be compromised.
Dr Fromme suggests several ways that Martha could bring about a better outcome for all concerned without running into professional or ethical obstacles. She could demonstrate empathy for her uncle's medical problem. ("It sounds like you've been feeling pretty ill. Can you tell me more?") She could then follow up and say, "It sounds like your symptoms are not going away and are bothering you—I think they're definitely worth getting checked out." To express a desire to help, she could say, "It sounds like it's been hard for you to get in to see your doctor. Would you mind if I called him to see if I could get him to see you sooner? I could even come with you."
"If Uncle John agrees, Martha will have met all three of her goals," Dr Fromme concludes. "She will have avoided examining or treating her uncle while ensuring that he gets good care and feels cared for."
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Neil Chesanow. When Friends and Family Ambush You for Free Medical Advice - Medscape - Jul 26, 2017.