Going the extra mile for patients: How friendly is too friendly?

Recently, a family in my practice decided to move out of state, back to where they had lived before. When we said goodbye, the mother said that she was sad to change pediatricians. The pediatrician they would be returning to, she said, “only takes care of strictly medical things.”

Clearly, she meant that I take care of more than the strictly medical things. I was flattered, especially since this was something she was sad to give up — but it got me thinking: am I too friendly?

Obviously, there’s more to health than the “strictly medical.” Lots of things, like stress, home environment, resources or lifestyle affect our health — and since as the doctor I’m in charge of health, I figure that stuff falls under my purview. It’s especially true, I think, in pediatrics. A child’s family, community, friends and school all have a big effect on how their lives play out in the short-term and long-term. I need to make that stuff my business, and I do.

But I kept thinking about that mother when I read a post on the New York Times’ Well blog called “When The Healers Get Too Friendly.” The author, a doctor, writes about how when she gave a patient a laptop she wasn’t using (that he needed), she did it on the sly, because “… gifts to patients, well, we don’t usually do that.” She pointed out that “… aside from indisputable sexual and financial depredation, no one agrees exactly where the boundaries lie.”

I am definitely someone with looser boundaries than most. I have given my personal cell number to certain families (the ones who really need it). I share stories about my children and my life, when it’s pertinent (shared experience, I’ve found, can make a difference). I have given clothes to families who needed clothes. I lent one mother my baby swing (it helped her colicky baby). I have gone to weddings, baptisms and funerals; I have visited dying children or grieving parents at home. I have given money sometimes, like the Friday night years ago when a mother told the nurse and me (long after other staff at the health center had left) that she didn’t have enough money to feed her children that weekend–and nowhere to get any money. Esther and I looked at each other and wordlessly went for our wallets. We couldn’t let them go hungry.

That’s the thing: being a health care provider can put you face to face with raw human need. Sometimes you can call a social worker or agency to help. But sometimes you can’t — and sometimes, simply being human requires that you respond.

We get warned about this issue of boundaries as doctors a lot, and it’s one that worries, puzzles and intrigues me. It sounds right, to keep boundaries — but in practice it’s far less clear how to do that, and why. Is it that being friends with our patients might cloud our judgment?  Is it that we might be more reluctant to ask or say something to our patients — or that our patients might be more reluctant to ask or say something to us? Do we — and this I think about a lot — run the risk of wanting patients to take care of us?

I don’t have the answers — maybe because the answers are likely different for each doctor, each patient, each family and each situation. Relationships are intricate and tricky things — but the power of relationship is real too. Good relationships build understanding and trust, which are both crucial for good care. I am careful and set limits where they are needed. I don’t know if I get it right every time, but I’d rather err on the side of being too friendly.

I made some inquiries for the mother, and found a pediatrician near their new home that a colleague described as “a good egg who goes the extra mile.”  That’s what I want for the family — it’s what I’d want for any family, including my own. When it comes to our doctors, the people who know our secrets and have such power over our well-being, we all deserve someone who will go the extra mile — and be our friend.

Claire McCarthy is a primary care physician and the medical director of Boston Children’s Hospital’s Martha Eliot Health Center.  She blogs at Thriving, the Boston Children’s Hospital blog, Vector, the Boston Children’s Hospital science and clinical innovation blog.

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