Guidance for ER Physicians Treating Loved Ones, Colleagues, or Themselves

By Christopher Cheney

When treating family members, friends, colleague, or themselves, ER physicians face ethical, professional, patient welfare, and liability concerns, a recent research article shows.

Similar to situations arising in the treatment of VIP patients, ER physicians treating loved ones or close associates may vary their customary medical care from the standard treatment and inadvertently produce harm rather than benefit.

“Despite being common, this practice raises ethical concerns and concern for the welfare of both the patient and the physician,” the authors of the recent article wrote in American Journal of Emergency Medicine.

There are several liability concerns for clinicians, the lead author of the article told HealthLeaders.

“Doctors would be held to the same standard of care as for other patients, and if care is violated and leads to damages, they could be liable. Intuitively, family and friends might be less likely to sue but that is not true of subordinates. In addition, as we state in the paper, for most ED physicians, practice outside of the home institution is not a covered event by the malpractice insurer,” said Joel Geiderman, MD, professor and co-chairman of emergency medicine, Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles.

Hospitals also have liability concerns, he said. “In California and some other states hospitals cannot directly employ doctors or control their practices. However, if they have policies in place and negligently allow rules to be violated, they could be liable.”

Ethical entanglements

ER physicians who care for loved ones, colleagues, or themselves encounter a range of ethical concerns:

• Autonomy: An ER patient seen by an ED physician loved one or colleague may feel reluctant to express a free choice regarding provider or treatment.
• Beneficence: A clinician has a duty to provide benefit to patients and guide patients to the most qualified physician.
• Nonmaleficence: In treating loved ones and colleagues, clinicians should not practice outside the limits of their training and abilities.
• Objectivity: Loss of objectivity is often the most daunting problem when ER physicians treat seriously ill loved ones and colleagues, with not only risk of harm to the patient but also the clinician if there is a negative outcome.

Practice guidance

Geiderman and his co-authors offer nine recommendations to limit concerns when ER physicians treat themselves and patients with whom they have a close relationship:

• Recognize the ethical, medical, and psychological considerations when treating loved ones and colleagues
• In all emergency situations, provide care until another clinician is available
• In general, risks are low when conditions are minor and episodic, and the possibility of failure is low
• Know the legal requirements and limits in your state, local, and professional jurisdictions
• If requested, give advice about other provider options
• It is generally acceptable to honor requests for help reviewing laboratory and imaging reports as well as interpreting physician orders
• Offer questions that the patient can ask the physician of record
• Encourage second opinions when the patient is uncomfortable with care
• ER physicians should lobby their professional associations to set policies for treatment of themselves, loved ones, and colleagues

It is challenging to set firm guidelines between minor and major conditions, particularly under emergency circumstances, Geiderman said.

“It is hard to be exhaustive. Ear aches, sore throats, simple wounds, and sprains are obviously minor. Long-term care and invasive procedures or life-threatening events like a rapid arrythmia or shock should be avoided. Physicians should exercise good judgment.”