To treat or not to treat
To Treat or Not to Treat Family and Friends
You have just finished a long day in the OR and finally make it home on a Friday night to receive a call from your sister. Apparently your 9-year old niece has a sore throat and your sister just wants you to call in a prescription so she doesn’t have to “deal with the Urgent Care Clinic.” Do you call in the prescription so you don't have to deal with any conflicts with your sister, or do you explain to her that you really shouldn't give her antibiotics unless there is a diagnosed bacterial infection but help her with palliative care suggestions? This is something we all face. If you haven’t yet, your time is coming. If it isn’t your family members, it may be friends, nurses or scrub techs in the OR, or your staff in clinic. What do you do when this situation is presented to you?
During our training we were commonly told to treat our patients as if we were treating our own family members. Yet, according to the American Medical Association (AMA) providers “generally should not treat themselves or members of their immediate families.”1 This seems contradictory. However, there are many reports that prove why we should not treat family and friends as well as countless lawsuits about people who have died from allergic reactions to medication that was prescribed without a documented visit. A recent post in the AAPA Huddle discussed this same issue and Robert Blumm, PA-C Emeritus, relayed several stories. The first was a “friend” who developed his first ever acute gout attack after ingesting a large quantity of steak and drinking many mugs of beer. Unfortunately, the “kind hearted” prescription of Allopurinol lead to a severe rash, which the friend then tried to treat on his own with Benadryl and steroid that he had already had at home. By the end of the week he had expired from Stevens-Johnson Syndrome. The wife had no choice of recourse other than to pursue a lawsuit against the provider that wrote the prescription without a visit. Another example demonstrated an anaphylactic reaction to medication leading to angioedema and subsequent death.
On the other hand, what if the situation is emergent and you are able to help that family member or friend? If you are on vacation and a friend or family member forgets their blood pressure medication that they have taken for 20 years. They are unable to get ahold of their PCP. Do you call in a couple days’ worth of the medication and make sure they follow-up once they get home or do you let them take the risk of not taking their medications? Or one of your friends’ kid sprain their ankle while at an out of town baseball tournament. Do you treat them there and call in some pain medications or have them go to a local urgent care and then followup with you once you get back home, in your clinic?
There are numerous situations in which providers will be challenged to treat without examination, full patient history and/or test results. Although it is difficult to tell friends and family no, you can still help them. Remember that you can still advocate for your friends, family and coworkers without putting your license at risk. Sometimes providing some feedback, information, or helping them with decision making or getting them into offices quicker is what they really need or want. How do you handle these situations? Does your practice have specific guidelines to help you with these situations?
1. American Medical Association (AMA). Treating Self or Family. Code of Medical Ethics Opinion 1.2.1. Available at: https://www.ama-assn.org/delivering-care/treating-self-or-family.