This month, Richer and Bereza debate this question: Should family physicians treat themselves or members of their own families or not? Richer ( page 781) says no, recalling the many risks inherent in self-treatment and treatment of those close to you. Her argument rests essentially on the Quebec physicians’ Code of Ethics1, which says that physicians should, except in emergencies or when the illness is minor, abstain from treating themselves or anyone with whom they have a relationship that could compromise the quality of their services, notably their spouses and children.
To this Bereza ( page 780) responds that, even if it is true that the rule is clear (that physicians should not be their own physicians),1 its application is not always so clear. Telling the story of a doctor, competent and respected by her peers, who became ill, he raises many questions that lead us to ask ourselves whether this rule is really practical. Among his objections, one of the most pertinent is certainly this: “What is the physician morbidity and mortality associated with adhering to the rule as it stands? Interestingly, that question is rarely asked, and consequently, there are few data to help us answer it. Without these data, the ethical calculus is one-sided.”
Without wishing to take sides in this debate, I have to admit that the question of self-treatment or treatment of those close to us gets a lot of reactions, particularly among physicians who don’t have their own physicians or who cannot find a physician. For, even if the rule is justified and codes of ethics are explicit in this regard, the rule doesn’t hold up in everyday life, as most physicians have already broken the rule at one time or another during their careers. Proof of this came in a survey3 conducted in 2006 among physicians in Montreal, which revealed that most of them had already prescribed laboratory tests (80%) and medications (60%) for themselves. And as it is unlikely that this was always only in emergencies or for minor illnesses, it is plausible that the phenomenon of self-treatment occurs much more frequently than we think and much more often than we admit.
Think about it. Who among us has not examined the ears of our own feverish child howling with pain in the night to discover whether the child has acute otitis media and to give him or her antibiotics? Who has not renewed a prescription for someone close to them, for a mother-in-law or a friend, to help them out? Who has not at one time or another raided (oh the shame!) the store of medical samples for an anti-inflammatory to relieve nagging back pain, for a proton pump inhibitor for stomach upset (probably caused by the former!), for a sedative before a long flight, or even for suppositories for throbbing hemorrhoids? Let he who is without sin throw the first stone.
So, if the phenomenon is as widespread as it seems to be and the evidence of deleterious effects is not yet established as Bereza contends, how do we justify this rule? Why shouldn’t physicians treat themselves and their families? After all, there are no rules against lawyers defending themselves in court, architects designing their own homes, accountants doing their own tax returns, or notaries preparing their own wills. What then is to prevent (the Code of Ethics is the rule in Quebec) physicians from treating themselves or their families if they believe they have the requisite skills? Are physicians less trustworthy than other professionals?
Advising physicians to abstain from treating themselves and their families is probably meant to control abuse. For, if most would agree that administering drops for an external inflammation is not too serious, it’s another thing when physicians prescribe antidepressants for themselves, try to manage their risk of commiting suicide or becoming dependent on narcotics, or take the chance of delivering their own babies. The risks inherent in these activities are much greater and the consequences much more disastrous.
Just like for codes of conduct, if we understand that certain limits are necessary, their application sometimes avoids problems. For example, the $400 ticket recently given to a mother who had the misfortune(!) not to hold the handrail on an escalator in the Montreal metro is a case in point. But as we all know: dura lex sed lex!
Remember that, for your own sake and for the sake of those you are close to, you must act in good faith with prudence and discernment.
Footnotes
Competing interests Dr Ladoucer is responsible for the Self-Learning Plan for Continuing Professional Development at the Collège des médecins du Québec in Montreal.
Rapid Response
Join the discussion at www.cfp.ca. Click on the Rapid Responses button on the home page or in the box to the right of the article.
Cet article se trouve aussi en français à la page 777.
References
1. Collège des médecins du Québec. Code de déontologie des médecins du Québec. Montréal, QC: Collège des médecins du Québec; 2002. pp. 1213–2002.pp. a. 70
2. Association des médecins omnipraticiens de Montréal. La santé des médecins. Bull méd omnipr Montréal. 2007;30(2):10.
Re: Should Doctors treat themselves or family members?
I'm not a medical professional by any means, but I don't think we should assume that all doctors would react the same way. I mean, a particular doc might be extremely methodigical such that he would always follow set procedures nevermind who the patient is. On the other hand, you could get docs who let their emotions rule themselves.
It all depends on the person. The safest option I guess would be to deem all docs to be likely to react on emotion and make it impermissible for all.
Re: Should Doctors treat themselves or family members?
Just personal observations of friends and relatives in the Med field. First a doctor is the worlds worse patient. For a doctor to have another doctor as a patient is to have the most argumentative patient imaginable. It is almost impossible for a doctor to treat another doctor and 1,000,000 times worse if the doctor happens to be himself/herself.
a doctor self-treating will often make one of 2 errors. Become stoic and refuse to acknowledge the seriousness of any symptoms or become a hypochondriac and see the worse in the most minor of symptoms.
Re: Should Doctors treat themselves or family members?
By law doctors aren't allowed to treat themselves or family unless in an emergency. But the guy above contends ''there are no rules against lawyers defending themselves in court, architects designing their own homes, accountants doing their own tax returns, or notaries preparing their own wills. What then is to prevent (the Code of Ethics) physicians from treating themselves or their families''
Many doctors don't themselves have doctors.. I have been shopping for one for a while and can't find anyone I'd be comfortable with and so I am doing without even though I feel currently that I need some help...
Text without context is pretext If your opponent is of choleric temperament, seek to irritate him
Re: Should Doctors treat themselves or family members?
format_quote Originally Posted by Woodrow
Just personal observations of friends and relatives in the Med field. First a doctor is the worlds worse patient. For a doctor to have another doctor as a patient is to have the most argumentative patient imaginable. It is almost impossible for a doctor to treat another doctor and 1,000,000 times worse if the doctor happens to be himself/herself.
a doctor self-treating will often make one of 2 errors. Become stoic and refuse to acknowledge the seriousness of any symptoms or become a hypochondriac and see the worse in the most minor of symptoms.
br. woodrow how true.. I am definitely type II .. I have diagnosed myself with everything under the sun and none of it is pleasant
plus I have every instrument I can buy without being held liable and constantly putting an EKG to myself or a spirometer, injecting myself with B12 complex lol
nothing is helping me of late though..
Text without context is pretext If your opponent is of choleric temperament, seek to irritate him
Re: Should Doctors treat themselves or family members?
My dad is a Doctor and he can't teat himself or anyone in my family as they have a personal cornections. We have to see another doctor so they can talk imparshal.
O Allah, I seek help from you. I seek your forgiveness. I seek your guidance. I believe in you.
Re: Should Doctors treat themselves or family members?
in times of trial like your going through just remember to stick to the middle path, dont go to extremes on either side of deen and inhshAllah itll help. i often loose my sanity trying to be too good, or becoming too lazy.
Re: Should Doctors treat themselves or family members?
i think it would be cool to be a doctor and to treat yourself but i honestly don't know whether its the right thing to do or not like we are all human and we do make mistakes whether your educated in this field or not and maybe you could misdiagnose yourself that maybe another doctor would spot the correct problem a mile off
Re: Should Doctors treat themselves or family members?
There should be limits as the article says, doctors should be allowed to treat themselves and family only to the extent where abuse can be avoided. How to set the limit is a different question, no one should allowed to prescribe antidepressants for themselves or sedatives for a distressed family member. It much easier to set the limit for all procedures, however more practical setting individual rules could be, especially in countries with a lack of medical professionals. And as Woodrow said, doctors in many cases avoid the help of their peers, especially for trivial issues which they could solve themselves.
Medicine deals with human life and well-being so one expects medical ethics will be much more prudent and severe than in other professions. A lawyer defending themselves may end up in jail for the rest of their lives (though I doubt anyone would choose to defend themselves under heavy charges) and are not banned from doing so, whereas a doctor is banned even from extending a prescription. That's wrong and unnecessary.
Re: Should Doctors treat themselves or family members?
I've just noticed there's a poll and it's quite intriguing. Doctors themselves certainly know theirs and their family history more than anyone else, however there are few medical conditions trivial enough so that human emotion and proneness to mistake under stress play little or no role and at the same time complicated enough for family history to matter a lot. I know little about diseases so far so the last sentence may be completely wacko.
Re: Should Doctors treat themselves or family members?
format_quote Originally Posted by Froggy
I've just noticed there's a poll and it's quite intriguing. Doctors themselves certainly know theirs and their family history more than anyone else, however there are few medical conditions trivial enough so that human emotion and proneness to mistake under stress play little or no role and at the same time complicated enough for family history to matter a lot. I know little about diseases so far so the last sentence may be completely wacko.
very true a dear friend of mine who was a doctor just dropped dead in April of 2004.. it really scarred me badly, to help so many people and not offer yourself help..
plus two colleagues of mine committed suicide in 2006 one by injection and another a pediatrician in the prime of her life gassed herself in her car
I don't think people realize how difficult it is to choose this career path and the difficulties at the same time in seeking someone else' counsel.
Text without context is pretext If your opponent is of choleric temperament, seek to irritate him
Re: Should Doctors treat themselves or family members?
I'm sorry, what I meant is what is the current stage of your medical education, are you a doctor yet or are you doing specialties. The terminology is entirely different here than it is in the US, I'm not sure how to phrase my question.
Re: Should Doctors treat themselves or family members?
I didn't vote because I think it depend on the situation, if its a normal treatment, but if it was doing operations then that's different story. Sometimes it can put their lives or the others' lives in danger like this scenario:
A friend of mine was a trainee doctor in the emergency unit at hospital. Her brother had an accident and she recognized him when they brought him. She didn't tell her trainer that the injured one was her brother because she was so worried about him. So she entered the operations room and at the moment the doctor cut her brother leg to insert the metal she fainted and fell down. The doctor scolded her because she broke the law of entering the operation room in such situation.
The girl is very brave with other people and did many operation but it wasn't the case with her brother.
I think its dangerous to let someone unstable emotionally at that moment to do an operation for a relative because s/he will be very scared and worried to do any mistake let alone being worried about that relative.
Re: Should Doctors treat themselves or family members?
you can't be emotionally un-invested least of which when it is a family member at stake..
that being said, I have and have seen many faint in the OR, believe it or not it isn't always because of the patient.. When I fainted it was just because of poor aeration.. and I am glad I fainted backwards .. and I am glad the surgeon wasn't an ass, I am so grateful it wasn't this guy goldberg whom everyone was positively horrified of or I'd never have heard the end of it..
Text without context is pretext If your opponent is of choleric temperament, seek to irritate him
Re: Should Doctors treat themselves or family members?
^ Is it emotionally okay for someone to see his parent's heart opened? or see him/her covered with blood and close to death?? *I feel faint just thinking about it*
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