The second issue relates to the dual relationship shared by these individuals, which is both professional and personal. Fisher R, Ury W, Patton B. It is not unusual for family and friends to ask for medical-related “favours”, often wrapped up with a degree of emotional blackmail, intended or otherwise. About 16 percent of all patients bring a companion -- a spouse, adult child, parent or friend -- to their doctor's appointments, according to a 2002 study in The Journal of Family Practice. In clear-cut situations, the patient must transfer to another physician following discussion as to the reason for the referral. Accepting a friend request from a patient on Facebook could be alluring for several reasons. Patients trust their doctors with information they may not have shared with any of their family or friends. Send it our way. We couldn’t let them go hungry. Please don’t send me a picture of your rash on Facebook Messenger. I'm not talking brochures and pamphlets -- I'm talking about the Internet (again). Forty percent of people ages 18-24 do not see a medical professional annually. You pay me to provide a service, yet what I give cannot be bought. James Hallenbeck, MD is assistant professor of medicine at Stanford University. Therefore, sites like FB and LI can play a role in maintaining those relationships. It is too simplistic to state that the relationship should not exist; the question, rather, is how does one best guard against a dual relationship resulting in harm? The family member will often need this information so they can make an informed decision about the next steps in medical treatment. "Look, Doug, with you as my doctor I don't need to go see some surgeon, you're doing a great job taking care of me.". The BMA says the fact that doctors have access to past health information about their patients and see them when they are feeling ill and vulnerable puts patients at a disadvantage. If it is clear that the professional relationship should not continue, then the major question is how best to break this news to the patient and explore the implications both for continued care (referral options to other physicians) and their friendship. The risk inherent in dual relationships, however, is that objectivity can become blurred by emotions or extraneous concerns—financial interests, for example, or one's status within a group or on the job. According to Pew Research, 69% of the U.S. public uses some type of social media. Communication:Good communication skills are essential to establish DPR. Patients worry about the future. Patients can expect a nurse to act in their best interests and to respect their dignity. Sometimes you can call a social worker or agency to help. While not explicitly stated, the wording of the case suggests that the physician is being pressured to prescribe opioids in a situation where they would not be appropriate—especially given the patient's refusal to consider other diagnostic and therapeutic options. Negotiation. It is always unethical and unprofessional for a doctor to breach this trust by entering into a sexual relationship with a patient, regardless of whether the patient has consented to the relationship. A particular risk in their case (and arguably in many friendships) is that a "slippery slope" may be encountered, in which "special considerations" insidiously lead from small acts of friendly kindness to requests for favors that lie outside the bounds of propriety. Quiz: What’s the ideal medical specialty for your personality? The biggest risk in this case is that the issues in dispute will be personalized. Doctors' practices are increasingly trying to reach their patients online. That way, patients can get useful information and a sense of their doctors as people, but privacy stays intact and physicians maintain distance. "They … There is now a renewed interest in medicine as a social process. In borderline cases, the potential conflict of interest should be disclosed and discussed with the patient, at a minimum, and a continuation of the relationship weighed against transfer of care. Doctors are divided on how strict the boundaries should be. Relationships with patients can pose a challenge to doctors at any point in their career, but trainees can particularly struggle when it comes to knowing where to draw the line in these situations, says Susan Hill, consultant surgeon in vascular surgery, University Hospital Wales, and a council member of the Royal College of Surgeons, England. It's … Would the prescription of opioids be within the bounds of reasonable practice? They're used to it. But sometimes you can’t—and sometimes, simply being human requires that you respond. When a physician is emotionally involved with a patient, that physician’s objectivity can be called into question. Legally, within the United States this right is based on battery statutes that guarantee freedom from unwanted touching [2]. The bottom line is that doctors have to beware of what they write on social networking sites, and who they share it with. “As an osteopathic physician, I went into this field to make differences in lives by not only treating disease but also through education and prevention,” Dr. Varshavski says. Communicating with your patients too frequently on Facebook or other social networks can be extremely off putting, uncomfortable and could completely tarnish your reputation. With Facebook specifically, it may be reasonable to have two separate profiles, one to share pictures and other personal information with friends and family, and another page (for instance, like the Fan page of this blog) that can be dedicated to professional use. Doctors sometimes get asked to treat friends and relatives but it is a situation they should avoid if possible, according to the Medical Defence Union. In many cases, patient refusal is not a major problem; acceptance or refusal of recommended therapy is well within a range of reasonable choices with minimal implications for care. And sometimes … Here, it is important to separate the people—patient and doctor—from the problem—that a conflict of interest can compromise care. Only serious or persistent failure to follow our guidance that poses a risk to patient safety or public trust in doctors will put your registration at risk. What about the dual relationship between the doctor and patient? Getting information and advice . I think the best safeguard against the danger is to abide by 2 principles: "the patient comes first," and "first, do no harm." "They should be … The Doctor and/or Patient Needs Help. New York, NY: Oxford University Press; 1994. “Social media is a tool doctors can use to continue this mission, one that can influence the health decisions of millions.”. Getting to YES - Negotiating Without Giving In. “Good medical practice relies on trust between doctors and patients and their families. I have never heard that it restricts a friendship. So there is no question but that the patient is within his rights to refuse a surgery consult. HIPAA doesn't prevent you from being friends with a patient, but it does matter where the friendship started and who initiated it. Refusal of care may also have significant implications for decisions by the physician. Its adviser, Dr John Holden, argues that it is all too easy for the doctors to put their livelihoods at risk. We help to protect patients and improve medical education and practice in the UK by setting standards for students and doctors. The friendship relationship makes it difficult to do. The short answer is that friendships and any type of relationship beyond strictly professional boundaries is not condoned. Communicating with your patients too frequently on Facebook or other social networks can be extremely off putting, uncomfortable and could completely tarnish your reputation. Doctor-patient partnership. Google,” which can generate anxiety and may even influence a patient’s perceptions of their symptoms. Each step down the slope seems reasonable enough, but, at a certain point, one realizes he is in trouble, and climbing back to safety seems impossible. Better known as “Doctor Mike,” Dr. Varshavski reaches millions weekly through his popular YouTube channel, as well as Twitter, Instagram and Facebook accounts. However, I have been around in enough places to see that, in many contexts, physicians do wind up being friends with their patients. Studies have revealed that effective communication between physician and patient has resulted in multiple impacts on various aspects of health consequence… While health information sourced from social media has been shown to help patients make better informed decisions, people must be certain they are seeking out credible sources and limiting consumption if it’s causing anxiety, cautions Dr. Caudle. But HIPPA is based around protection of personal information. Focus on the pros of dating a doctor. The survey also found nearly two-thirds of millennials and 43% of all adults feel it is appropriate to contact their physician(s) about a health issue through social media either by posting on their page or direct messaging them. Over the past few years, the U.S. Department of Health and Human Services has instituted numerous policies and standards to guide practitioners who use social media. What you say to a doctor or a fellow nurse might be very different to what you would say to a patient and their family. In this case, the patient has taken the position that he does not want to go to the surgeon and he does want more painkillers. Recognizing and adjusting to barriers in doctor-patient communication. At the simplest level, competent patients have a clear right to refuse any medical therapy, based on the ethical principle of respect for autonomy [1]. Many doctors are very empathetic, and have a true passion for what they do. Friends and relatives will remember vividly the bad times, when the patient was in pain, even if it lasted a short while and was then relieved. A child’s family, community, friends and school all have a big effect on how their lives play out in the short-term and long-term. Indeed, the patient has already done so, by dismissing consideration of the surgery consult because "Doug" is such a great doctor. While I have addressed these 2 ethical issues—the patient's refusal of recommended treatment and the patient-friend-physician relationship—separately, they come together in terms of the communication skills needed to manage the situation. The very nature of a dual relationship implies that the physician has some investment in the relationship beyond his or her professional role. How do you know when a dual relationship is on a dangerous slippery slope? He is also the hub-site director for the Department of Veterans Affairs Interprofessional Palliative Care Fellowship Program. Dr. Cleveland has been treating Mr. Neezer for 20 years, and they've been fishing buddies for at least 15. The family member will often need this information so they can make an informed decision about the next steps in medical treatment. We invite submission of visual media that explore ethical dimensions of health. This line need not be defined by the law, but rather as a personal guideline for both patients and doctors. A doctor can do as much harm to a patient with the slip of a word as with the slip of a knife. Should you let him. Choose your words to fit the situation and the audience. Although these guidelines do not specifically mention friends, the reasons given for not treating family members apply equally to friends. Generally doctors are a sympathetic group and can find such requests difficult to refuse, even in the knowledge that treating family and friends is frowned upon. For most physicians, the establishment of good rapport with a patient is important. Making friends as an adult can be weirdly difficult. Long COVID may have an explanation: What physicians should know, Social support linked to success in managing diabetes, JAOA research suggests, Medicine: The Musical theater and performance dates announced, Two DOs are now Tony Award-winning Broadway producers, Upcoming webinars cover COVID-19 vaccines at work and E/M coding changes, Compendium of behavioral health integration resources now available, The safest hospitals in each state, according to Leapfrog, The top 10 highest paying medical specialties in 2019. ... offer no explicit rules about friendships with former patients. If you have consent, you can speak about a friend or relative's health with their GP. This means that a nurse abstains from obtaining personal gain at the patient's expense and refrains from inappropriate involvement with a patient or the patient's family members. Should a doctor back away from a blurring of these boundaries? Social media as a platform to share health information. Dating a doctor can get frustrating at times, but remember the pros. and requests stronger pain control, while refusing to schedule the surgery consult that Dr. Cleveland has recommended. Online social networking has introduced new aspects to this old question. It almost goes without saying that, when it is clear from the outset that a dual relationship poses a serious risk, professionalism requires that the physician not serve in the professional role. Physicians who are doing a service in the medical community need to realize they must not be in a relationship or form a friendship with any patient for security reasons. If … I'm not sure if they just regret giving you their number after getting to know you a little bit better and are trying to use HIPPA as an excuse, or if they have some rule at that hospital that says you can not be friend a patient. Fisher and Ury also introduce the term, BATNA (best alternative to a negotiated agreement). Copyright 2021 American Medical Association. ", "And besides," he said, "Medicare won't cover all of it.". He consistently asks Dr. Cleveland "What're we going to do about this pain?" Health professionals are broadly prohibited from communication over social media if any information shared could be used to identify a patient. However, understanding the patient as much as possible from the start can save a lot of time in subsequent visits. And sometimes I give really good advice, but the patient doesn’t believe me because I’m not really their doctor. They vary in intensity from minor—treating a member of a common social organization such as a church or work group—to major—treating a family member. ISSN 2376-6980. Coping with ambiguity and uncertainty in patient-physician relationships: III. Alice, Can you explain to me why I should not be bothered by the fact that my girlfriend goes to a male gynecologist (actually a group of four doctors). Principles of Biomedical Ethics. Using the language of Fisher and Ury in their book, Getting to Yes, separate the people from the problem [12]. In my role as a primary care doctor, I ask patients about their families. Convenience and best interests are not the same but patients will often confuse the two. Informed consent and disclosure in the physician-patient relationship: expanding obligations for physicians in the United States. The positive and negative implications of this for the patient's health care must be addressed more directly. Research has found “health anxious” individuals may not benefit from increased access to online health information, forums and “Dr. Use the word ‘medicine’ rather than ‘drug’ when talking to patients. In the middle of the century when science and technology emerged, interpersonal aspects of health care were overshadowed. Overcoming Obstacles in US Health Care Delivery with a New Practice Model for Family Practice, Martey S. Dodoo, PhD and Andrew Bazemore, MD, A Physician's Role in Informing Family Members of Genetic Risk, Four-Year Residency Training for the Next Generation of Family Physicians, Marguerite Duane, MD, MHA and Robert L. Phillips, Jr., MD, MSPH, Patient-clinician relationship/Difficult relationships. While the physician cannot control the response of the patient, he can avoid making the same mistake of personalizing the situation. Getting professional help from a doctor, practice nurse, or a school or college nurse will give your friend or relative the best chance of getting better. Initially Dr. Cleveland tried to treat it with muscle relaxants and referred Mr. Neezer to a physical therapist. She says, no, doctors should not be friending their patients: Having a so-called dual relationship with a patient — that is, a financial, social or professional relationship in addition to the therapeutic relationship — can lead to serious ethical issues and potentially impair professional judgment. Doctors are usually intelligent and committed to their patients. I suspect that the dual relationship between Dr. Cleveland and Mr. Neezer developed slowly over time.