The Golden Rule

Physicians are supposed to be impartial. We ought to approach each patient as if she were our own mother (or grandmother or daughter). We should treat our patients without judgment; although we attend to each person individually (and take into account her personal desires, preferences, beliefs, and decisions), we should not treat patients differently based on our feelings toward them. I was taught long ago that if I had a patient who was in jail or charged with a crime, I should not inquire too much into their offense (so long as its not medically necessary) because I don't want to color my subjective perception of the patient.

This is a long preface to address the opposite circumstance. Recently, one of my coresidents had a family member who needed surgery. We talked about who we'd want as their anesthesiologist and surgeon, and to a greater degree, pondered how we would provide that anesthetic. Would I change my anesthesia if my patient were rich or famous or a friend? A couple things here - we are advised not to treat our loved ones. Taking on multiple roles and assuming a patient-doctor relationship with someone we are close to is a bad idea. It creates conflict, interpersonal tension, and provider bias. We also try to treat "VIP" patients just as we would anyone else.

But is this really the case? I think it's hard to know until we are put in that situation. For example, there are multiple ways of doing an anesthetic. I can achieve the same outcome with a completely intravenous anesthetic and an inhaled anesthetic. The intravenous anesthetic has a lower risk of nausea but a potentially higher risk of awareness and increased cost and labor. Would I prefer one technique over another if my patient were a family member? There are also monitors with no proven benefit; for example, we occasionally use an intraoperative EEG to assess depth of anesthesia, but the device has never proven to be superior to current standards of measuring anesthetic depth, and the cost is not insignificant. But would I add it on to the care of a patient who was particularly rich or famous? I'd like to think that sort of thing wouldn't affect me, but I cannot say until I find myself in that situation.