Context Is Key When Nonpatients Ask for Medical Advice

Pam Harrison

January 09, 2018

Guidelines that discourage physicians from providing medical advice or treatment to family members and friends (nonpatients) may not be feasible, as these requests raise complex issues and physicians need to be properly trained to negotiate them in a safe manner, a study suggests.

"All physicians in our study had experiences with requests for medical care from nonpatients," Esther Giroldi, PhD, from the Care and Public Health Research Institute, Maastricht University, the Netherlands, and colleagues write. "Our findings provide a framework for understanding how physicians engage with these requests," they add.

The report was published online January 8 in the Annals of Family Medicine.

The researchers detailed the experiences and thinking behind how physicians respond to medical requests from nonpatients by using focus groups led by an experienced behavioral scientist. "We completed 5 focus groups with junior physicians and 2 focus groups with senior physicians," they note. In total, the groups included 33 junior physicians (residents in the first year of the family medicine specialty training program at Maastricht University) and 16 senior physicians.

"A range of factors emerged as important considerations for physicians when they receive a medical request from a nonpatient and determine how they respond," the investigators report. First and foremost, physicians orient themselves to the specific situation. "Some settings were considered more practical and confidential for diagnostic purposes than others," they write.

For example, "If it's at a party, then the answer's 'no,' " one participant noted, for in that situation, he or she is not a physician but simply another guest. A party or a family gathering is also not considered private enough to give any medical advice. "[T]he nature of the request itself ('what') seemed to be the most important [question] for physicians, because it determined the urgency of the situation," the authors state.

Situations considered to be an emergency rendered all other factors "irrelevant," given that physicians felt it was their duty to respond to the request immediately. In situations that physicians felt to be less urgent, they would take into consideration the nature of the medical request itself and respond accordingly.

In addition, the closeness of the physician's relationship was a key consideration in deciding whether to respond to a nonpatient's medical request or not: the closer they felt to the person, the more likely they would be to respond. Feelings of personal responsibility engendered by the closeness of the relationship might also prompt physicians to give the person advice or even treat them without being asked to do so, "for example, if they recognized a medical condition that the nonpatient was unaware of, or saw that a nonpatient's existing medical condition was deteriorating," the authors explain.

Professional curiosity might also prompt physicians to respond to medical requests, they note. Furthermore, physicians who were more confident in their own knowledge and professional skills were more likely than those who were less confident in their medical expertise to field a nonpatient's request. Regardless of whether they were junior or senior physicians, both groups had concerns about losing their "objectivity" if they were to care for members of the family.

Junior physicians also expressed concerns about making a mistake if they responded inappropriately to a nonpatient's request, and that this mistake could lead to patient harm. Physicians who felt they had made a mistake in the past were less likely to respond to any new requests. Last, physicians noted that they did not want to interfere with any relationship the person might already have with their own treating physician and, as such, were disinclined to respond to a nonpatient's request.

"The main reasons offered by international guidelines for being cautious when responding to requests relate to concerns that objectivity may be compromised, taking a history or performing a medical examination targeting sensitive areas could be inadequate, and physicians could be inclined to treat problems beyond their expertise," the researchers observe. However, the decision to respond to a nonpatient's request for medical advice is not arrived at in the absence of social context. For example, patients often seek advice first from a family member or a friend before visiting a physician, and if that family member or a friend happens to be a doctor, then asking their advice informally is a normal step before seeking formal care.

"When considering this broader context of the sociology of health access, it becomes clear that any simplistic application of the current guidelines to not give advice or treatment to relatives is not feasible," investigators write. "This is a complex space, and physicians require training and experience to negotiate these issues safely," they conclude.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. Published online January 8, 2018. Full text

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