The day I got into medical school, my uncle said to me, “You are going to be a doctor! We finally have a doctor in the family. You are going to take care of your uncle in his old age.” Other family members echoed the same sentiment. First doctor in the family. Now, we will all have free medical advice.
As I progressed through medical school, then internship and residency, then finally to being an adult hospitalist, I often received questions from my family.
What’s this rash? Why does it hurt when I urinate? Is it bad to have blood in my stool? Even one night after my mom finished watching a medical drama, “Karen, what is the sepsis?” They seemed to think I was an expert in every medical specialty. I answered their questions as patiently as I could but always feeling slightly uneasy. Even with conditions I commonly treated and counseled patients on, I always felt a bit hesitant when a family member asked me. Somehow, the stakes were higher with a family member. Perhaps it was because I was afraid my answer would be wrong and I could potentially harm them. Perhaps I wanted to remain standing on that medical pedestal of knowledge they had placed me on. I was not sure.
I knew other doctors who had no reservations whatsoever treating their family members. Writing prescriptions for that antibiotic. Ordering that chest X-ray. Reading their family members charts. One colleague even told me she had been acting as her parents’ personal physician for years, managing every infection, every hyperglycemic and congestive heart failure episode.
But as much as my family wanted me to, I could never truly be their “family” doctor. I always answered politely to my family members’ questions. However, I prefaced each answer with phrases such as “this is just my opinion” or “you really should ask your doctor.” This would be met with, “Well, why can’t you be my doctor?” or “My friend’s daughter is a doctor and she prescribes medications for her.”
I thought about their words. Why couldn’t I be their “family” doctor?
One day, my mother asked me, “should we put your grandmother on hospice?”
I stared at her aghast, automatically saying, “No, why would we do that?”
My mom replied, “Well, the doctor suggested hospice. Your grandmother’s health has deteriorated over the last couple of years. The doctor recommends we make her quality of life a priority. Those are her words. What do you think?”
“Mom, of course, we should not. We would never do that. That does not make sense at all.”
As I said those words, it suddenly dawned on me. I could never be the “family” doctor because there was too much bias. I was too close to the situation. My grandmother had diabetes requiring insulin, hypertension, hyperlipidemia, congestive heart failure and she was obese. She barely walked anymore. To add to all of that, she had been recently diagnosed with an unknown primary cancer with metastases to the liver. We had chosen not to have her undergo the battery of tests the doctors had recommended. If this patient had been anyone but my grandmother, wouldn’t I also recommend hospice? Yes, I would.
I am not saying it is unethical or wrong to treat one’s family members. However, for me, personally, I do not trust myself to be emotionally detached enough to be able to give good objective advice to a family member. It’s not to say that I don’t still get those questions and that I don’t still answer. But at least now I know why I cannot be the “family” doctor.
Karen Yeter is a hospitalist.
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