Treating Friends and Neighbors in Rural Primary Care

I’ve been dealing with this for almost 40 years now since I graduated from my Family Medicine residency in Lewiston, Maine some time in July 1984 and I’m not stewing about it anymore. But one of the things that happens when you mentor younger colleagues is they ask about things you resolved early in your career and then almost forgot about. Because sometimes you are the only doctor in town, or the only available doctor, and you end up having to see a patient you already know socially or the other way around, a patient of yours enters your life in one way or the another, how does one maneuver that?

First, as a doctor, my job is to recognize pathology when I see it. I avoid getting involved socially with people who seem angry, bitter, seductive or needy in some way.

Sometimes I can’t even remember, now after the fact, which relationship came first. In some cases there were horse people who became patients, in other cases there were patients who also ran business I ended up hiring.

One example is the Winslows. I can’t remember if I met Donald as a patient first or if he and his wife first stopped by to look at my horses and to offer me and my wife first dibs of buying the neighboring land they no longer needed. We bought the land and years later, my wife gone and one of my horses dead from old age, I reached out to them and offered to board their horse as horses always do better with a mate. I boarded their horse for a couple of years and now he is here permanently. I switched jobs and am no longer Donald’s doctor, but he plows my driveway and I pay him for it.

Or Wendy, who came over with her husband to look at my white Arabian princess soon after I moved to Caribou with my wife and our two horses. They ended up getting a divorce and my wife and I got a divorce. For a while after that I saw both Wendy and her husband as patients, and now I see neither, since I switched to a housecall practice.

There are some basic consideration in any relationship that is both social and professional. The local grocer doesn’t give cash discounts at the supermarket for his friends and the town attorney is probably just as careful as I am to treat all clients equally and fairly.

In some ways I think it is trickier to navigate social media than in-person relationships. Many years ago, while a married man, I opened a Facebook account which I quickly closed down after several female patients wanted to “friend” me.

I opened one again as a single man and was very careful to limit the number of “friends” I acquired. It’s one thing to let people know what the town doctor is up to as far as pets and hobbies, but I don’t look for updates about what all my patients are doing. I simply don’t have enough time in my life for that.

I can think of a few instances where a social connection with a patient has played an emotionally significant role in my life. One was the woman I wrote about in a post called Off the Record. Her husband had had a vasectomy and she became pregnant by an old sweetheart she met at a class reunion. Her husband supported her decision to have the baby and accepted the newborn boy as his own, saying “vasectomies sometimes fail”. I delivered their baby while I was a resident. I admired both of them for their love and commitment. My wife and I had them over once and we never saw them again. The other instance was the bed-bound minister, writer and publisher I wrote about in I am Here, Doctor. She kept encouraging me to write, but never lived to see me become a published author.

As a doctor, you have to be a friend to your patients, but there are boundaries between friends just like there are boundaries between neighbors. If a friend does something big for me, I expect to pay them and if a patient takes on a job for me, I pay them just like I would a friend.

I guess it matters how close you are. If you’re just friends, you reimburse each other, if you are family or really close, you may not need to. But we have to be careful not to use our position of power/influence over patients that enter our social circle. We must be extra careful to keep our relationship outside the office on a perfectly equal basis.