Comments and Controversies
Treating family members
I enjoyed the article by Drs. Mossman, Farrell, and Gilday addressing the practice of physicians prescribing medications for relatives or friends (“Should you prescribe medications for family and friends?” Current Psychiatry, June 2011, p. 41-51). I would like to add additional reasons why physicians may accept or decline a relative’s request for treatment.
Some doctors treat relatives out of a desire to reciprocate for financial or emotional support, or to compensate for deficiencies in other parts of their relationship.1 Other reasons to treat include convenience for the relative by not having to wait for an appointment, or for the relative’s physician by not wanting to bother them with a minor problem and associated paperwork.2 A belief that the physician-relative can offer better care than what is available or currently provided has been given as a motivation for treatment.3 The fear of misdiagnosis and a subsequent guilty conscience have been offered as reasons to refrain from treating family members.1 Other doctors refrain from treating because of role conflict or the possibility of treatment noncompliance; a relative may not follow the treatment plan seriously because of familiarity with the physician.2,3 Interestingly, a desire for confidentiality has been given as a reason to either treat or refrain from treating family members.1
Because most physicians will be solicited for treatment from family members or friends during their careers, I applaud the authors for addressing this topic. Increasing awareness of guidelines, reasons for and against treatment, and recommendations for treatment should be a priority in medical school curricula and graduate medical education.
Jonathan R. Scarff, MD
Resident in General Psychiatry
University of Louisville
1. Boiko PE, Schuman SH, Rust PF. Physicians treating their own spouses: relationship of physicians to their own family’s health care. J Fam Pract. 1984;18(6):891-896.
2. Reagan B, Reagan P, Sinclair A. ‘Common sense and a thick hide’. Physicians providing care to their own family members. Arch Fam Med. 1994;3(7):599-604.
3. La Puma J, Stocking CB, La Voie D, et al. When physicians treat members of their own families. Practices in a community hospital. N Engl J Med. 1991;325(18):1290-1294.