Should a doctor treat their own family members?

Dear Viki,

What is your take on doctors who take care of patients with whom they have a personal relationship including families and how should hospitals deal with this?

Thanks for asking this question. This is an ethical problem that is regularly ignored and has always bothered me. The quick answer is that doctors shouldn’t treat loved ones unless it is an emergency and no other doctor is available or if the patient is in an isolated place and no other doctor is nearby. This would never be the case in a hospital setting where another doctor is readily available. Hospitals should have a policy against this behavior.  This may be more difficult to deal with in rural communities but every effort should be taken to protect the patient.

I have heard doctors tell me that they can be objective. They may think that they are able to be objective, and maybe one or two can, but they can’t change what the patient is experiencing. Patients may not be willing to tell the whole truth to their family member, may be embarrassed to be examined by the family member and may feel pressured to do what the doctor/family member says even though they disagree with the plan. And it doesn’t have to be only with family members. It can also be a problem with friends who are healthcare providers. Doctors should hold themselves to the higher standard and live by their own professional code of ethics.

Here is what the American Medical Association has to say about it in the physician’s Code of Medical Ethics:

E-8.19 Self-Treatment or Treatment of Immediate Family Members

Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination. Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member. This discomfort is particularly the case when the patient is a minor child, and sensitive or intimate care should especially be avoided for such patients. When treating themselves or immediate family members, physicians may be inclined to treat problems that are beyond their expertise or training. If tensions develop in a physician’s professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.

Concerns regarding patient autonomy and informed consent are also relevant when physicians attempt to treat members of their immediate family. Family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. In particular, minor children will generally not feel free to refuse care from their parents. Likewise, physicians may feel obligated to provide care to immediate family members even if they feel uncomfortable providing care.

It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available. In addition, while physicians should not serve as a primary or regular care provider for immediate family members, there are situations in which routine care is acceptable for short-term, minor problems.

Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members. (I, II, IV) Issued June 1993.