- Avoid treating anyone with whom you have a close personal relationship, except in an emergency.
- Avoid treating staff members and their families wherever possible.
- If you do need to provide treatment, document your treatment carefully and refer to another practitioner as soon as possible.
Guidelines issued by the Medical Board of Australia say that whenever possible, doctors should avoid providing medical care to anyone with whom they have a close personal relationship.
It is absolutely inappropriate to provide the following types of care to family members except in emergencies:
- prescribing or administering drugs of dependence
- prescribing psychotropic medication
- undertaking psychotherapy
- performing surgery.
If you do provide such treatment, you may be called on to justify your actions to the disciplinary body in your state/territory.
Why should I avoid treating family and friends?
There are a number of reasons why providing care to close friends, family members, or those with whom you work can be unsafe and inappropriate.
Lack of objectivity and professional distance
You may find it awkward and/or refrain from asking sensitive questions or conversely it may be difficult for the patient to disclose sensitive information to you, so you may miss vital information.
Taking and/or providing a complete history or full physical examination may be uncomfortable for you and/or the patient and may result in you not completing a full assessment.
It can be very challenging to maintain objectivity. For example, you may feel pressured to provide a particular treatment that you would not otherwise provide.
What you know about the individual outside of the consultation room might influence your management of them, for example if they are non-compliant with medication.
Any of the above factors may mean you do not gather full and correct information, or follow-up on appropriate investigations and referrals and can lead to a missing or missed diagnosis.
A scenario that can see doctors before professional tribunals is where they are persuaded to prescribe medications to family members or friends.
In some cases, prescribing has occurred over long periods. However, one-off requests may also occur in informal situations outside the doctor-patient relationship.
In South Australia it is prohibited to prescribe Schedule 8 drugs for family members unless it is a verifiable emergency. In other states and territories, there is no legislation prohibiting medical practitioners from prescribing for family and friends. However, every prescription you write comes with clinical, ethical, and legal responsibilities including the obligation to prescribe only where there is a clinical justification, and to make appropriate records of prescriptions.
Discontinuity of care
A significant risk is a lack of continuity of care, particularly where doctors are persuaded to just write up a script or referral or conduct a “corridor consultation”.
In these circumstances, documentation may be informal or non-existent and there may be no proper handover or follow up. Patient care can be severely compromised if other treating practitioners are unaware of previous treatment or medication, or of differential diagnoses that have already been considered.
Damage to personal relationships
In the course of a consultation, you may find out something about the individual’s medical history or circumstances that you would rather not know.
An unforeseen outcome may result in conflict within the family or other relationships.
Why would treating staff members be problematic?
Many of the above issues also apply to treating staff members and their families, and there are some additional issues to consider in this situation.
A staff member may access the medical record of another staff member or a family member/friend without a clinical need to do so. This may be a breach of privacy and a notifiable data breach. The situation could become even worse if the staff member who accessed the medical record discusses it with other people.
Complete and accurate clinical records
You might be tempted to mask a record (e.g. by using a false name), or not to include sensitive information in the medical record. For example, you might choose to exclude information about HIV status or illicit drug use to protect your patient’s privacy. This would mean the medical record was not accurate and complete, making it difficult for another doctor to treat the patient in your absence.
Conflict of interest
You might gain knowledge about a staff member or colleague’s medical condition because they are a patient, but you cannot use that knowledge for employment issues such as fitness for work. You might be asked to write a worker’s compensation certificate arising from an injury at work. This potentially creates a conflict between you as a practice owner/doctor and you as a treating practitioner.
Damage to employment relationships
A treating and employment relationship may come into conflict. Your knowledge of a staff member’s medical history or personal circumstances may impact upon your management of the employer-employee relationship and could potentially lead to concerns about discrimination.
If an employment relationship breaks down, this could also compromise the treating relationship.
A staff member or family of the staff member may expect a discounted or free service.
Is it ever appropriate to treat family, friends or staff?
If you practice in an isolated or rural community it is not uncommon for your professional and private lives to intersect.
In emergency situations or isolated settings where there is no other qualified doctor available, you should not hesitate to treat family members, friends or staff until another doctor becomes available.
While you should not serve as a primary or regular treating practitioner for immediate family members, there are situations in which routine care is acceptable for short-term, minor problems.
If you do have patients in your practice who are staff members or known to staff, make sure you have formal structures and policies in place to manage the situation. This would include details about who can access the medical records, guidelines about staff who request a script or an opinion for a family member or
themselves. Having policies in place can assist doctors to say no if they are concerned about a request for treatment.
If you do choose to treat family, friends, staff and the family of staff:
- Set boundaries and expectations about the treatment you will provide.
- Ensure you have appropriate systems in your practice to protect against privacy breaches.
- Ensure medical records are complete and up to date.
- Avoid engaging in “corridor consultations” – ensure that consultations are formal and appropriate time is set aside for you to make considered clinical decisions.
- Arrange follow-up if required.
- Communicate with the individual’s treating practitioner about treatment you have provided (with the consent of the individual).
What about treating yourself?
Avoid testing, treating or prescribing for yourself. All the issues about objectivity and continuity of care are compounded if doctors attempt to diagnose and treat themselves. The Medical Board of Australia states that good medical practice involves:
- Having a general practitioner.
- Seeking independent, objective advice when you need medical care, and being aware of the risks of self-diagnosis and self-treatment.
Medical Board of Australia – Good medical practice: a code of conduct for doctors in Australia
Medical Council of NSW. Guideline for self-treatment and treating family members
You can find additional resources including articles, podcasts and webinars in the Avant Learning Centre under Professionalism and ethics
This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published. [August 2020]