It seems so simple: your wife has occasional migraine headaches and you write prescriptions for her. Your neighbor and long-time friend has a backache after last Saturday’s touch-football game, so you see him in your office for a quick check-up. Or in another instance you might see a friend of a friend as a favor; and you routinely care for your parents.

After all, you are a physician and you know what you are doing; so what is the harm in taking care of the people you care about, or doing an act of kindness for a friend? At least you know that they will get good care, right?

If you find yourself in these or similar situations, you have entered an area of risk. Caring for immediate family or close friends, caring for someone as a favor for family or friends, or even caring for yourself can be both ethically and medicolegally unsafe behavior for a number of reasons. For instance:

a      You may be too close to the person to ask questions which will obtain a thorough history

a      You may be too uninvolved or distant from the person to ask those same necessary questions

a      Your clinical evaluation may be more cursory than it would be with a regular patient

a      It can be difficult to be completely objective when you are evaluating someone you are close to

a      Legally, a physician-patient relationship is created the moment you write a prescription for someone else even if you have not evaluated them or created a medical record for them

All of this leads you into potential risk situations. Becoming a friend or family member’s physician along with your personal contact can result in a strained relationship. Yes, family and friends will sue you. It is difficult in any circumstance for a physician to endure the allegations of a lawsuit; and in some cases they know that they did fail to note a key symptom or order a timely test. Those circumstances are even more traumatic when they are compounded by a damaged personal relationship.  

The American Medical Association (AMA) Code of Medical Ethics asserts that “physicians generally should not treat themselves or members of their immediate family.” It also allows that “while physicians should not serve as primary or regular care providers for immediate family members, there are situations in which routine care is acceptable for short-term, minor problems.”[i]

What guidelines do you have in these circumstances? Federal government laws relate specifically to controlled substances and require that the physician-patient relationship include maintaining a written medical record.[ii] Each state can specify more stringent rules; for instance, Iowa actually prohibits self-treatment or treatment of immediate family members except in emergencies.[iii]

New Jersey Board of Medical Examiners (NJBME) regulations in section 13:35-7.1A notes “a practitioner shall not dispense drugs or issue prescriptions to an individual…without first having conducted an examination, which shall be appropriately documented in the patient record. As part of the patient examination, the practitioner shall:

1. Perform an appropriate history and physical examination;
2. Make a diagnosis based upon the examination and all diagnostic laboratory tests consistent with good medical care;
3. Formulate a therapeutic plan and discuss such plan, along with the basis for the plan and the risks and benefits of various treatment options, with the patient; and
4. Ensure the availability of the physician or coverage for the patient for appropriate follow-up care.”

Although New Jersey’s regulation does not specifically prohibit a physician from treating themselves or their immediate families, these care-giving instructions rule out any casual provision of medical treatment.

No matter what variations appear between treatment laws and guidelines, they all focus on the tenets of good medical practice. Patients are not treated without a history, an exam, and a functioning, up-to-date medical record. As noted, New Jersey’s regulations, in particular, are very specific about the detail of care which is required in these situations.

The NJBME also recognizes that care may be rendered with less attention to all these details in true emergencies; but treating one’s family and friends does not often qualify as an emergency. The concerns of this article, therefore, apply. A casual approach to care of family and friends does not give you or them the protection all of you deserve.