Early and Late Career Collaboration #3: Doctor in the House?

by Hans Duvefelt, MD and Lilian White, MD

(Already posted but somehow ended up “unpublished”)

I have written before about not letting your concern for a patient get in your way of being rational and levelheaded. I have also written about being told that I seemed to care more about my sick patients than my own family members when they’re sick. Now, in my collaboration with Lilian White, I am turning my attention to being involved as a doctor or an advocate when a family member needs medical care.

I remember once, visiting my parents in Sweden, that my uncle was hospitalized with transient stroke symptoms. This was many years ago. At least back then, hospital bed-days were of less concern than expensive tests. My uncle was simply admitted for observation and no tests were done. I asked one of the nurses if I could borrow her stethoscope. I then listened to his heart and his carotid arteries. His pulse was perfectly regular, so no sign of permanent atrial fibrillation, and I did not hear a carotid bruit.

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“No bruit, but you still need a carotid ultrasound”, I said to my uncle as I returned the stethoscope to his nurse. I know she heard me, but she said nothing. I never did get to talk to the doctor.

When I developed high blood pressure and reluctantly saw a colleague of mine for it, I told him my theory that I’d be best treated with a beta blocker, metoprolol, because (at the time) I was a type A personality, hard working, ambitious and slightly hotheaded. My colleague obliged, even though metoprolol wasn’t a typical first choice anymore for hypertension.

I have prescribed antibiotics for family members with tooth or sinus infections. This can count as permissible emergency care. And, just like Lily, I have coached them on questions to ask when they see their doctor. I have also bandaged plenty of wounds and even used superglue on cuts before Dermabond was introduced here in 1998 - we had something similar long before that when I worked in Sweden.

I have also guided family members away from seeing the doctor or going to the emergency room when their condition seemed to be something self limiting. But, I’ll confess, I am more cautious doing that when someone other than yours truly is the patient. Heck, I diagnosed my own vitreous detachment during a visit in Sweden and waited until I returned here to have an ophthalmologist confirm my self-diagnosis. I was right.

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Here’s Lilian White’s post:

Being a physician is as much or more a part of our identity as it is a career. Even the phrase “being a physician” seems easier to say than “working as a physician”. We don’t stop being a physician when we walk through the door after a day at work.

There is a good amount of controversy surrounding physicians caring for their friends or family members. I personally recall very strict boundaries to not even *consider* caring for a friend or family member in my medical training. The concern was that our personal bias would alter our judgement and result in substandard care or difficult situations.

And yet, when that friend or family member gets sick, how could we not contribute in some way to relieve their suffering?

Over the last few years, I’ve frequently been in a caregiving role. When a family member was in the hospital, my involvement and care led to a timely admission, better quality of care, and reduced time to discharge.

However, I’ve also experienced the reverse: where I was impatient and unkind in response to a family member’s complaint after a long day at work.

So should doctors be involved in their family and friends’ care? I think it’s inevitable not to be. We know the patient well, and our input through the lens of our medical experience is valuable. I also think it’s wise to have other physicians involved in their care primarily, but to not make use of our inherent knowledge is to waste a resource that could be incredibly helpful to that person’s relief. I’ve found it helpful when I hear a concern that either I can’t or don’t feel comfortable addressing directly or that would be better managed by another physician, I share questions or options that I would recommend asking their physician. “Ask them what they think of this diagnosis,” or “Consider asking what they think about XYZ treatment”. In this way, I’m able to offer help or sometimes even advocate for the patient without assuming the role of their physician (unless necessary).

What do you think: should doctors be involved in caring for their friends and family?