Physicians are highly regarded for their skill, professionalism, and dedication to helping others. Many times, physicians become the “go-to” person for families, friends, and colleagues in need of medical advice or attention. Yet the desire—and pressure—to go above and beyond for those closest to you and/or for select patients can be difficult to navigate and lead to blurred boundaries, clouded judgment, and exceptions to routine protocols, which can put you and your patients at risk for suboptimal outcomes.
Doctors as Patients
Treating another doctor comes with a unique set of challenges and considerations. Knowing that your patient is a fellow physician can affect your behavior and communication, and impact care.¹ In a 2022 Medscape poll, more than half of the physicians who responded admitted to treating their physician-patients differently from other patients.²
Doctors frequently assume that their physician-patients know more about their medical condition, treatment, diagnosis, or upcoming procedure than they do.¹ This kind of assumption can lead to limited information sharing, minimal explanations about conditions, and presumptions that the patient is adhering to treatment plans and is forthcoming with relevant details.¹
Doctors may also assume that their physician-patients expect them to spend more time or provide informal or off-the-record consultations. It is also a common assumption that physician-patients assess their doctor’s expertise. This assumption can create anxiety or a tendency to second-guess recommendations, and at times, lead the treating doctor to defer to the physician-patient to direct their care.¹ It may also be more challenging for both the physician and patient to ask questions or to correct misinformation for fear of contradicting a peer.
Friends and Family Members
While there are no laws prohibiting a physician from treating a family member or close friend, the Medical Board of California discourages this practice.³
At first glance, refusing to treat family members seems like a simple line to draw, but in fact, treating family and close friends is a widespread practice among physicians. Prescriptions of antibiotics, antihistamines, and contraceptives are among the most common treatments.4 In a 2010 survey, an overwhelming number of plastic surgeons indicated that they had performed a procedure on a family member, with 88% stating that they would operate on a family member.5 Even physicians who have made it a point not to treat family members may find themselves in difficult situations. Scenarios such as a family vacation when their six-month-old nephew presents with symptoms of an ear infection or a dinner party where their brother-in-law discloses symptoms of recent onset of headaches and blurry vision are good examples of how the physician may be positioned to help, but should they?
Because of the inherent intimacy with family members and close friends, a physician’s professional objectivity may be disrupted by their emotional involvement with the patient.6 Their personal sentiments on treatments, interventions, and recommendations could result in potentially dangerous outcomes5 and make it difficult for family member patients to get second opinions or ask questions, depending on the family dynamic.
As a result, ethical guidelines indicate that physicians should not treat family members and/or non-patients except in cases of emergency or minor short-term issues.4
"VIP" Patients
Despite being met with the usual discontent by staff and providers, the very important patient (VIP) remains an existing patient classification in many healthcare institutions. These patients are often celebrities, CEOs, local government officials, or otherwise well-connected persons in their communities.7 Perks for these patients not only include comfort enhancements, such as superior patient menus, hospital suites, or a personal concierge, but also preferred clinical services, such as easy access to the most sought-after providers, and expedited care. Yet for physicians, the pressures that sometimes accompany treating VIPs and the expectations associated with better service and clinical outcomes can create the opposite effect and negatively impact care, a scenario nicknamed “VIP syndrome.”7
One significant contributor to VIP Syndrome is the tendency to steer away from established protocols to expedite services for the VIP patient. This can be in the form of eliminating routine preliminary tests, creating alternative schedules, or rushing through standard practices and protocols.8 These changes are often made with good intentions to minimize a patient’s discomfort or inconvenience, but can result in staffing issues, clinical gaps, and staff resentment towards the patient. VIP patients often have a hospital administrator overseeing their experience. This additional spotlight can lead to increased anxiety for the treating physicians and staff, and decreased privacy for the patient because of unwanted attention or visits from hospital CEOs or department chiefs.
Best Practices
In many ways, the same best practices and risk-reducing strategies that you would employ when treating all patients come into play when treating different classifications of patients. Providers should have an awareness of the complexities that can accompany treating certain patients, and recognize when the typical issues or pressures of these relationships are present.
Person-Centered Care
Hippocrates said, “It is more important to know what sort of person has a disease than to know what sort of disease a person has.”9 The idea of person-centered care is tailoring the care to meet an individual’s needs. It is important to acknowledge the patient’s individuality, lifestyle, experience, and care goals. For a physician-patient, acknowledge their background without assumptions, so you avoid the trap of limiting communication or information. Instead, engage them in discussions about their care and be open to their input or suggestions. Your VIP patient may have specific concerns regarding how treatment may impact their lifestyle or schedule, and in turn, you can try and tailor the care plan to help meet their needs and preferences when appropriate.
Clear Communication and Expectations
Whether treating a VIP, friends or family, or a physician-patient, it is important to set clear boundaries. With each of these types of patients, there may be the perception—whether accurate or not—that they require more time or access to you. Set boundaries from the outset as to your hours, expected response time, and the appropriate contacts for scheduling visits. You should not provide your personal cell phone number or feel the need to respond to non-urgent issues after-hours. Let your patient know that they need to schedule a visit to discuss their care. Efforts to initiate care discussions at a family barbecue or a physician-patient request for a personal hallway consult should be redirected to the appropriate channels.
Adhere to the Fundamentals of Excellent Care and Know the Legal Implications
Dr. Benjamin Ansell, UCLA professor at the David Geffen School of Medicine stated, “The fundamentals of patient care need to be the same, regardless of wealth, influence or celebrity.”10 In the scenarios we have discussed, there is a tendency to circumvent protocols in the pursuit to increase efficiencies and accessibility, or meet patient demands and preferences. Providers may even find themselves in the “backseat.” Instead of a collaborative shared decision-making approach, the patient is driving the care. As much as providers should respect patient values and knowledge, roles should be clarified, with you as the clinical expert, providing your professional guidance and recommendations. Legally, you are the one held accountable to the standards of care in your field of medicine. Regardless of a patient’s insistence, you should not entertain treatments that you would not recommend. You will have to be able to provide clinical justification for your care decisions.
With friends and colleagues, you need to know when a patient-physician relationship has been established. Once you begin treatment, even if for a short-term issue, you are accountable for the interaction, the documentation of it, and the consequences.
Being aware of the dynamics of these patient classifications and staying grounded in the patient-physician relationship are key to navigating the challenges that you may face. Remain faithful to your clinical expertise and judgement, and you will be equipped to successfully provide quality care to any patient.
Yvette Ervin, JD, is a Senior Risk Management and Patient Safety Specialist. Questions or comments
related to this article should be directed to YErvin@CAPphysicians.com.
References
¹Noriega C., Three things you need to know when your patient is a doctor, Medical News Today, Healthline Media UK Ltd., 2017 Jul 12,
https://www.medicalnewstoday.com/articles/318033#How-assumptions-can-af…
²Lehmann C., Docs Treating Other Doctors: What Can Go Wrong?, Medscape, WebMD LLC, 2022 Dec 16,
https://www.medscape.com/viewarticle/985690?form=fpf
³Frequently Asked Questions, Complaint: General Office Practices/Protocols, Medical Board of California, CA.Gov, Accessed 2024 Aug 1, https://www.mbc.ca.gov/FAQs/
4Latessa R., MD, Ray L., MD, Should You Treat Yourself, Family or Friends?, FPM, AAFP, 2005 Mar, https://www.aafp.org/pubs/fpm/issues/2005/0300/p41.html
5Nesvig K., A Plastic Surgeon Operated On His Wife. Now He’s Being Arrested For Manslaughter, Allure, Conde Nast, 2024 Jun 21,
https://www.allure.com/story/florida-plastic-surgeon-arrested-for-mansl…
6AMA Council on Ethical and Judicial Affairs, AMA Journal of Ethics, American Medical Association, 2012 May, https://journalofethics.ama-assn.org/article/ama-code-medical-ethics-op…
7Rockwell H., Keller EJ., Tadros A., and Newton I., VIP Patients in Interventional Radiology: Do Some Patients Deserve ‘Better’ Care?, National Library of Medicine, ncbi.nlm.nih.gov, 2022 Nov 17,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9671680/
8Adderton J., Are Patients Cared for Equally? Challenges of the VIP Patient, All Nurses, allnurses.com, Accessed 2024 Aug 1,
https://allnurses.com/are-patients-cared-equally-challenges-t693358/&nb…;
9Coulter A., Oldham J., Person-centered care: what is it and how do we get there?, National Library of Medicine, ncbi.nlm.nih.gov, 2016 Jun,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465833/ (August 1, 2024)
10Schlossberg J.A., Let’s talk about ‘VIP syndrome’, UCLA Health, uclahealth.org, 2020 Oct 13, https://www.uclahealth.org/news/article/lets-talk-about-vip-syndrome