When a doctor's child is ill

Source: TV Guide

Towards the end of season one of In Treatment, the HBO series about a therapist’s sessions with his patients, a young woman asks psychotherapist Paul Weston if he ever analyzes his own daughter.
“It’s just not a good idea,” he replies. “It’s not possible to treat one’s own children.”
“Why?” Sophie, the teenage patient asks.
“Parents play a big role in the development of the child’s personality. So as a doctor it would be very hard for me to keep my role as a father separate from the therapy.”
“Because you are part of the problem,” Sophie states.
“Correct.”
Can therapists ever really escape the training that has taught them to observe and analyze? What about medical doctors? Do they worry more or less than other parents about their children’s health? Does emotional involvement cloud the judgment of a doctor who attempts to treat a family member?

Are physicians held to a higher standard?

A recent essay in The Journal of the American Medical Association (JAMA), “Is There a Doctor in the House?”, describes the plight of one physician whose child had frightening seizures. The issue was not simply one of emotions and objectivity, but feeling judged by other medical professionals.

During one of his many seizures, our son was ill with croup and turned unmistakably blue. Well rehearsed in the process by now, I called 911 immediately, unwilling to risk respiratory arrest while waiting for diazepam to take effect. One of the paramedics, upon learning that I am a physician, chastised me for calling them prior to its administration. His manner was condescending and I felt sheepish, yet watching the ragged breathing of my pale and lethargic son, I felt my decision was justifiable. Is it reasonable to think that a physician should have a higher threshold for seeking medical attention? To the contrary, I felt that to expect of me a greater tolerance for the suffering of my own child was to demand the impossible. …
I remain … just another concerned mother in the examination room. I desire nothing more than to ask questions, comfort my child, and receive reassurance from physicians I trust, free from diagnostic or therapeutic responsibility. Some physician-parents might prefer to take the lead in coordinating care. … Candidly, though, when it comes to my children, sometimes it’s more comfortable to be told what to do.

In this example, the physician-mother was not trying to treat her son. She simply wanted prompt attention in an emergency. But it’s not uncommon for friends and family members to ask a physician for advice and treatment.

Should doctors treat their relatives?

This is a controversial question. Most professional organizations for physicians, in their statement of ethics, advise against treating oneself and one’s family. Here’s a sample from the American Medical Association:

Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination. Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member….
It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available.

Some of the reasons physicians end up treating relatives:
• Family members may not hesitate to ask for advice.
• Physicians may feel obligated to offer their opinion simply because they want to be available to their families.
• Physicians may feel embarrassed if a family member consults another physician about a condition that appears to have a simple solution.
• Physicians may disagree with the advice a family member receives from another physician.
• It may be more convenient or less expensive to treat a family member than to pay for a visit to another physician.
A classic study on physicians treating family members was published in 1991 in The New England Journal of Medicine, “When physicians treat members of their own families. Practices in a community hospital.” Results from the 465 physicians (M.D. or D.O. degrees) surveyed:
• 99 percent had been asked by family members for medical advice, diagnosis, or treatment.
• 83 percent had prescribed medication for family members.
• 80 percent had diagnosed a medical condition.
• 72 percent had performed a physical examination.
• 15 percent had acted as a family member’s primary physician in a hospital.
• 9 percent had operated on a family member.
• 33 percent had observed another physician “inappropriately involved” in the medical care of a family member.
• 22 percent said they had responded to a specific request, even though it made them uncomfortable.
An article in the Annals of Internal Medicine asks the question: “What Do You Do When Your Loved One Is Ill?”. The advice: “Physician-family members can ask themselves, ‘What could I do in this situation if I did not have a medical degree?’ and consider avoiding acts that require a medical license.”