Treating Family Members

A recent JAMA article discussed the issue of doctors treating people they have personal ties with. These can be familial or intimate ties, but also close social ties (as in friends). In general, these professional relationships are highly discouraged. Obstetricians don't deliver their own babies. Doctors don't see friends and patients in the clinic or hospital setting. Indeed, doctors don't diagnose and treat themselves. Often, the reason cited is a lack of objectivity. You don't think it could be cancer, because it's your husband, and he couldn't possibly have cancer. You can't imagine your child has a genetic disease; neither you nor your spouse has it. These thoughts get in the way of patient care. Perhaps the patient-doctor relationship would be blurred with the friendship; perhaps things would be awkward outside the clinic. Or what if the patient had a terminal illness or a grave disease; how would this affect the relationship?

On the other hand, I think that knowing someone well gives you more insight than anyone else. You already have a strong bond with the other person; you can trust them, you know how much they exercise or what they eat. You're part of their social support, you know they'll be more compliant with their medications, you have a driving incentive to give them the optimal care. Indeed, this article discussed doctors in small towns where everyone knows each other. The doctors will take care of patients and then see them that evening at a social event. They will have cared for generations of families. Is this a barrier to good patient care? I doubt it. The patients like it. The doctor's emotional ties propel the physician-patient relationship forward. And on a practical level, it's hard to find a solution to delivering health care to small towns.