Issue 39 / 8 October 2012

HAVING a relative who is unwell can be a challenging experience for a doctor.

My dad recently died of metastatic melanoma. During his illness, I experienced many difficult situations, which I’m sure were not unique. My experience made me think about the unusual role of physician-relative and how best to manage the situations that doctors can face.

Physicians are known to struggle with objectivity when they take a history from a relative, often either under- or over-interpreting symptoms.

Before his diagnosis, Dad told me about his unusual symptoms. Although I did not take a formal history, I gave my opinion as to what the symptoms meant. Because I was emotionally involved, I never wanted to hear anything that suggested sinister pathology.

I didn’t ask questions to identify “red flags” and I convinced myself that Dad’s symptoms were benign. As a result, I may have falsely reassured him. The potential delay in seeking objective medical advice may have adversely affected his prognosis.

I have always agreed with British and American guidelines, which recommend that doctors do not treat their immediate family. I didn’t appreciate, however, that by giving my opinion, I was, in effect, providing treatment. I should have recommended that Dad see another doctor immediately.

When Dad did see another doctor and a management plan was initiated, another problem arose as I disagreed with a crucial part of the plan.

This situation is known to be complicated for physician-relatives, as it tests the boundaries between personal and professional roles. I didn’t know whether to call the doctor and request a change of management, change the management myself, ask a medical friend to change the management or get a second opinion.

Articles addressing this issue have suggested that physician-relatives ask themselves: “What would I do in this situation if I did not have a medical degree?”

This is good advice as it removes the more controversial options that aren’t available to non-doctors. I chose to get a second opinion, which was the right thing to do in the situation. Dad’s management was changed and I hadn’t become professionally involved. I simply acted as an advocate.

One doctor, with Dad’s consent, sent me a copy of Dad’s scan report. It stated that the finding was most likely benign. However, there were features consistent with something more sinister. Dad had only been told that the finding was most likely benign.

I was then in the awkward situation of knowing more than my Dad and the rest of my family. While it is often tempting to obtain as much information about a relative’s illness as possible and particularly reports or laboratory results, it can actually make things more complicated and cause more stress.

When Dad was in hospital he often felt more comfortable telling me about new symptoms than his treating doctors. Deciding what information to pass on to the treating team was difficult as I felt like I should filter out what I believed were irrelevant concerns.

In retrospect I probably should have passed on more information than I did — just as we shouldn’t have information our relative doesn’t have, we probably shouldn’t have information the treating doctor doesn’t have.

Other physicians who have experienced the role of physician-relative have described it as “harrowing” and at times “terrible”. I agree with these sentiments.

I found work stressful as sick patients reminded me of my sick father. I found home stressful as I had become the family medical spokesperson and adviser. I felt that I had to stay calm and not show I was upset, otherwise my family would think the worst was going to happen.

It is important to recognise that the role of physician-relative is known to be stressful and to look after yourself accordingly.

While it is a difficult role, there are positive aspects to being a physician-relative. I enjoyed being able to help Dad through the medical process. He appreciated having someone there who understood “the system”.

I also now have a greater appreciation of what my patients and their families go through and I hope this has had a positive impact on my work.

I think the best advice to lessen the stress of the role is to decrease your professional involvement. See yourself as a well informed advocate rather than your relative’s doctor.

Also remember that the role is known to be difficult. You will be much better placed to help your relative and your family if you remember to look after yourself.

Dr Helen Robinson is a medical registrar in Brisbane.

Posted 8 October 2012

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6 thoughts on “Helen Robinson: Treating family

  1. Steve Hambleton says:

    There is a parallel with the doctor becoming a patient themselves. I tell my doctor patients that I recognise that they are very well informed and I do expect them to have a much more interactive relationship with me. I am happy to consider treatment options and I just know they will be single mindedly researching their condition.
    As treating doctors of patients with medical relatives it is up to us to allow that doctor opportunities to interact with us to the degree that they are comfortable. Sometimes a conversation with a doctor relative will uncover those issues of greatest concern to our patients, as Helen indicates above, which they might find hard to share. With chronic conditions or palliative care that level of participation will change and we all should be able to achieve the best of both worlds.

  2. drjohn says:

    I agree with Steve except perhaps this bit “I just know they will be single mindedly researching their condition”
    I think many doctors already know the information. If anything, they will be less likely to bring the annoying and often irrelevant Wiki article.

  3. John Boxall says:

    Over the years I was in practice I adhered to the philosophy that one should not get too involved in the management of one’s own family when they had significant medical issues. This sadly is something I now regret as both of my parents suffered significantly as a result of some of their treatment, some of which could have been prevented possibly had I intervened. I suppose our attitudes to various things in life are affected by our own experiences and I certainly will have no hesitation in getting involved with the management of any other members of my family when I think it is necessary.

  4. Dr A says:

    Thank you for this thoughtful piece. It resonated with me, as one of my parents died last year after a short and devastating illness. I found the concurrent roles of youngest child and doctor very challenging to negotiate, even in the “well informed advocate” role. However many of my mother’s treating doctors seemed to very quickly grasp the family dynamics. I was very appreciative of their quiet support for me, as well as the rest of my family, which, in my opinion, extended far beyond the call of duty. I agree that a positive aspect of being a physician-relative is being able to help with and hopefully streamline and demystify the ‘journey’ within the medical system.

  5. stevek says:

    Whilst the extreme situation of the story is similar to so many stories we all may share, it does overlook the truly benign situations which are the truly frequent circumstances of treating our family members.
    Surely we should NEVER prescribe opioids or for intimate issues (eg, contraceptives for daughters … but should we also not advise re condoms for sons???) There are dark and difficult areas of medicine where family is involved.
    However, should I avoid getting some antibiotics for my teenage daughter with tonsillitis on the weekend before it gets worse as it usually does, if there is a difficulty in getting her to the GP? Can’t I learn from the last 12 episodes and do what our GP does whilst we get there in fair order? (She just had them out …)
    Most family issues are well within our ability to discern wise from stupid, and the discussion seems always limited to the hard end. Should I have sent my secretary to another doctor, and not lance her paronychia on the spot? She is like family to me …. these are not hard questions, but the discussions do not address the ‘safe’ end very well at all.

  6. Billy says:

    At a WONCA conference in the USA in the early 70s I met a GP who had to deliver his wife of their first child because they were snowed in. She refused to let anyone else deliver her later children. I have found that most of the simple problems in children can be easily treated and even when they grow up ask for input. There have been a number of occasions where I was able to get investigations and consultations done much quicker than a colleague could. Such was the case when my son developed osteomyelitis. As a result he was left with no disability. My wife, another who refuses to have another GP, woke up with her first attack of auricular fibrillation so when I took her to hospital we had the ECG and were able to get on to the consultant. Being a GP with a hospital appointment right up to retiring, even when it became a teaching hospital, may have put me in a special position but I have found that looking after or giving advice to the family has only been positive

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