Treatment of Self, Family, Friends, and Employees

The unique dynamics of a close interpersonal relationship can often complicate the patient-physician relationship.

Below is information to assist physicians to remain in compliance with the rules and ethical guidelines for treating oneself, family members, friends, or employees.

Texas Medical Board (TMB) Rules

From TMB rules Chapter 190.8(1)(M) - Violation Guidelines

The following acts, practices, and conduct are considered to be violations of the Act:

Inappropriate prescription of dangerous drugs or controlled substances to oneself, family members, or others in which there is a close personal relationship that would include the following:
(i) prescribing or administering dangerous drugs or controlled substances without taking an adequate history, performing a proper physical examination, and creating and maintaining adequate records; and
(ii) prescribing controlled substances in the absence of immediate need. "Immediate need" shall be considered no more than 72 hours.

American Medical Association (AMA) Ethical Guidelines

The AMA Code of Medical Ethics states that treating oneself or a member of one's own family poses several challenges, including concerns about professional objectivity, patient autonomy, and informed consent. Refer to the complete opinion under Patient-Physician Relationships Opinion 1.2.1 Treating Self or Family.

Texas Medical Association (TMA) Ethical Guidelines

TMA Board of Councilors Opinion: Treatment of Family Members and Friends
One of the physician's primary duties is to alleviate suffering. Thus, it is ethical to treat family and friends. As with all patients, in the course of treating friends and family, a medical record should be maintained. However, in urgent or episodic situations generating a medical record may not be practical or possible.

However, please note that the legal requirements for treating family members and friends and for keeping medical records exceed the above ethics opinion. See TMB rule 190.08(1)(M) above. Consult your own retained counsel for legal advice on this issue.

Treating Your Own, It's Legal But It Can Be Risky- An article from TMA, Texas Medicine, October 2011 issue, that discusses some of the concerns and ethical considerations.

While treating a family member or friend is not against the law, it raises ethical concerns such as:
  • Loss of professional objectivity. The physician may make assumptions and fail to ask key, sensitive questions routinely asked of any other patient.
  • Risk of going beyond expertise level. The physician may feel an obligation to seek out every possible solution or take measures that normally would be referred to someone else.
  • Reluctance of patient to communicate openly. The patient may feel uncomfortable revealing info that is embarrassing or contrary to a family belief system.
  • Loss of patient autonomy. The patient may feel uncomfortable questioning the physician's judgment or obtaining a second opinion.

A poor outcome could affect the family or friendship as well as alert the TMB to a possible violation of the rules. This is especially true if the physician makes a mistake or error in judgment.

If you decide to treat friends or family members, stay on the good side of the law by treating them the same as any other patient.
For example:
  • Do not treat a friend or family member outside of your normal practice setting.
  • Do not treat a friend or family member outside of your field of practice.
  • Have the patient complete a new patient information form upon initial treatment.
  • Keep complete medical records.

Texas Medical Liability Trust (TMLT) Guidance

TMLT provides guidance and risk management considerations for a variety of situations - Proceed with caution: treating family, friends, and staff from The Reporter, Volume 3 2011, beginning on page 6.

Treating Employees

Physicians are sometimes asked to treat staff members. Thinking about the issues and establishing your own personal guidelines can make the situation easier to manage. There may be select cases where treating is the best option; however, a physician should consider the following carefully before making the decision to treat. Below is guidance form TMLT's The Reporter, Volume 3 2011, page 11.

1. Consider whether treating staff would create exceptions that are in conflict with your professional standards of care. Examples would be treating without completing a physician examination or without diagnostic testing.
2. Consider whether you can be objective when treating this person as a patient.
3. Does your employee need specialized medical care that you cannot provide?
4. Consider HIPAA privacy issues and protect your medical records.

If you decide NOT to treat an employee, be prepared to give supportive responses.
1. "That is something you might want to consider talking to your physician about" can express your concern without giving a medical opinion.
2. "There are legal and ethical reasons that make it ill-advised for me to treat you" will allow you to support the patient in other ways, such as referral or going with him or her to the ED for care.
3 Physicians may want to consider communicating their guidelines on treatment during staff meetings or in the practice's policies and procedures manual.

If you decide to treat an employee, comply with TMB rules.
1. Establish a proper professional relationship as defined by the TMB.
2. Establish and maintain medical and billing records as you would any other patient.
3. Use the same standard of care as you would for any patient in your practice. Order diagnostic testing, prescribe medications and treatment, and make referrals as necessary.
Following proper treatment protocols and documenting the encounter should serve as protection for both physicians and patients.