How Should I Be My Brother’s Keeper?

I saw Shrink Rap’s recent blog on whether or not doctors should treat their own family members psychiatric problems:

Dad It reminded me of an extraordinary situation in which I found myself a number of years ago in which I was the treating psychiatrist of record for my brother who was hospitalized with delirium.

Amazingly, I could not find another doctor to cover for me. The emotional conflict was prodigious. I googled a few articles, one of which was an online article at ACP Internist where I found a remark which seemed to fit my quandary,

Physicians will always encounter requests for care from their own family members and significant others. We need to acknowledge that in some cases answering these requests directly can result in strained family relations, as well as compromised medical care and physician-patient relationships. Often, the most caring and professional response one can offer is to help the person negotiate the health care system, leaving direct medical care to others. By refusing to be your brother’s doctor, but assuring him that you will advise him and make referrals, you may most rigorously fulfill the commandment to be your brother’s keeper (boldface type mine).

However, it would have been impossible to advise him because he was delirious. I made clinical decisions based on what I thought was my knowledge of what happened to him. A question came from a colleague about the another possible cause of his delirium. It bothers me to this day because it probably should have occurred to me and might have if my reasoning had not been clouded by the family relationship.

Which brings me to the American Medical Association (AMA) opinion about the ethics of treating oneself and one’s family members. The general recommendation to avoid treating one’s family unless there’s an emergency made sense in light of my own experience.

Delirium is a medical emergency.

I found varying opinions in my online search. The  AAFP article seemed to leave a lot of room for a physician’s own judgment, which was more strongly worded by another author, who sharply criticized the AMA position statement. An article on the BMJ Careers site expressed similar opinions although tried to straddle the pros and cons fence.

Based on my experience, I don’t prescribe for myself or my wife. However, I’m sure there are many whose opinions differ from mine.

What do you think? Could you still be your brother’s keeper by refusing to be his doctor? Would you want your brother to be your doctor?

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Comments

  1. Jim,

    I think these situations are common in rural settings and settings with few psychiatrists. It is a good reason to avoid the small town area you came from if you can. Even in specialty centers with an overlapping catchment area the chances are high that you will know some people that you treat or their families. I have observed treatment situations deteriorate – even when there was only a passing acquaintance, largely through unrealistic expectations of the patient’s family members.

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  2. What a horrible situation for you, and your brother.

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