Residents' Prescription Writing for Nonpatients

Aboff, Brian M.; Collier, Virginia U.; Farber, Neil J.; Ehrenthal, Deborah B.

doi:10.1001/jama.288.3.381

Cited by 17 publications

(19 citation statements)

References 8 publications

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“…In 1997, a survey of 92 internal medicine and family medicine residents in Delaware was conducted to evaluate whether they would write prescriptions in twelve hypothetical scenarios; two of the twelve vignettes involved a sibling or child (Aboff et al 2002). Of 74 residents completing the survey (or 80%), 95% of them were willing to write an antibiotic for a visiting sibling with sinusitis, and 77% would have provided an antibiotic for their child with otitis media.…”

Section: Direct Interventionmentioning

confidence: 99%

When Physicians Intervene in Their Relatives’ Health Care

Scarff

Lippmann

2012

HEC Forum

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Physicians often struggle with ethical issues surrounding intervention in their relatives' health care. Many editorials, letters, and surveys have been written on this topic, but there is no systematic review of its prevalence. An Ovid Medline search was conducted for articles in English, written between January 1950 and December 2010, using the key words family member, relatives, treatment, prescribing, physician, and ethics. The search identified 41 articles (editorials, letters, and surveys). Surveys were reviewed to explore demographics of these treating physicians and reasons for and against intervention. Physicians often intervene directly or indirectly in the health care of relatives. The most common reasons were convenience, cost savings, and the perception of having greater knowledge or concern than colleagues. Lost objectivity, fear of misdiagnosis, and inability to provide complete care were the main considerations against intervention. The characteristics of treating doctors were nonspecific. Most surveys recommend against this practice except for emergencies or minor ailments. This review included only a few surveys with small sample size and only assessed scientific literature written in English after 1950. Survey data may be biased by physicians' self-reporting. In conclusion, most doctors occasionally intervene in their relatives' care. The decision to do so is determined by multiple factors. Physicians should treat only short-term or minor illnesses within their scope of practice. Future research should evaluate doctors' attitudes toward their relatives, medical student feelings about treating family, and intervention frequencies of medical and nonmedical professionals.

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Section: Direct Interventionmentioning

confidence: 99%

When Physicians Intervene in Their Relatives’ Health Care

Scarff

Lippmann

2012

HEC Forum

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“…8,9 Additional reasons for not treating relatives include not feeling responsible for the relative's health care, family conflict, loss of confidentiality, fear of misdiagnosis and guilty conscience, denial and/or burden of diagnosing a serious illness, and inconvenience. [10][11][12] Various medical organizations discourage doctors from treating relatives except for short-term or minor conditions, isolated settings, or emergencies. 8,9 Nevertheless, people often seek medical care or advice from clinician-relatives, and the majority of clinicians oblige these requests.…”

Section: Teaching About Professional Boundaries In the Medical Schoolmentioning

confidence: 99%

“…13 Ethical and emotional concerns have been offered by physicians as reasons for participating in treatment, including inherent gratification, reciprocating or compensating (often toward spouse or parents) for financial or emotional support, and submitting to pressure; questing for power; maintaining good relationships and avoiding feeling guilty by denying care; and not trusting colleagues or perceiving oneself as more skilled, knowledgeable, caring, or altruistic. [10][11][12][13][14] No research has assessed student attitudes toward treating relatives, or whether or how this topic is addressed in the undergraduate medical curriculum. However, White found that a majority of students considered it inappropriate to offer medical opinions in a social setting outside of formal practice (and, therefore, without record keeping); yet this is the most common context in which relatives' requests for intervention are made.…”

Section: Teaching About Professional Boundaries In the Medical Schoolmentioning

confidence: 99%

“…4 Of interest, reasons given by medical students for running errands for a supervisor are similar to those cited by doctors who choose to treat family members. [10][11][12] The development of professionalism in students is influenced by behavioral and social science principles that can be taught in ethics, behavioral science, and introduction to clinical medicine classes, and during clinical rotations. These settings represent prime opportunities to present information that will help prevent future boundary violations.…”

Section: Teaching About Professional Boundaries In the Medical Schoolmentioning

confidence: 99%

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Teaching about Professional Boundaries in the Medical School Curriculum

Scarff

Lippmann

2013

ANN BEHAV SCI MED EDUC

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“…1 More than 99% of physicians receive requests from family members asking for medical advice, diagnosis, or treatment, 2 and 85% of physicians have written at least 1 prescription for a nonpatient. 2,3 Reasons for providing care to family members include convenience, cost savings, and the perception of having greater knowledge or concern than colleagues. Yet physicians may also decide not to intervene in the care of relatives or friends, concerned by a lack of objectivity, fearing misdiagnosis, or recognizing an inability to provide complete and continuous care.…”

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confidence: 99%

Family Physicians Managing Medical Requests From Family and Friends

et al. 2018

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PURPOSE Although guidelines generally state that physicians should not treat their family members or friends (nonpatients), physicians regularly receive medical requests from nonpatients. We aimed to explore junior and senior family physicians' experiences with and attitudes toward managing medical requests from nonpatients. METHODSWe conducted a qualitative study with 7 focus groups with junior and senior physicians. We performed a thematic analysis during an iterative cycle of data collection and analysis.RESULTS When confronted with a medical request from a nonpatient, physicians first oriented themselves to the situation: who is this person, what is he or she asking of me, and where are we? Physicians next considered the following interrelated factors: (1) nature/strength of the relationship with the nonpatient, (2) amount of trust in his/her own knowledge and skills, (3) expected consequences of making mistakes, (4) importance of work-life balance, and (5) risk of disturbing the physician-patient process. Senior physicians applied more nuanced considerations when deciding whether to respond, whereas junior physicians experienced more difficulties dealing with these requests, were less inclined to respond, and were more concerned about disturbing the existing relationship that a person had with his/her own physician.CONCLUSIONS This study provides insight into the complexity that physicians face when managing medical questions and requests from nonpatients. Facilitated group discussions during which experiences are shared can help junior physicians become more confident in dealing with these complex issues as they formulate their own personal strategy regarding provision of medical advice or treatment to family and friends. 2018;16:45-51. https://doi Ann Fam Med

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Residents' Prescription Writing for Nonpatients

Cited by 17 publications

References 8 publications

When Physicians Intervene in Their Relatives’ Health Care

When Physicians Intervene in Their Relatives’ Health Care

Teaching about Professional Boundaries in the Medical School Curriculum

Family Physicians Managing Medical Requests From Family and Friends

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