OPINION 17
ausdoc . com . au 9 AUGUST 2024
OPINION 17
Insight
Just say no to your family
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Associate Professor Chris Hogan OAM GP in Melbourne , Victoria .
We should avoid the domestic version of the corridor consult .
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Everyone who comes to us as a patient needs to respect us , and trust us , for us to do our job well .
We are the keepers of a great many secrets . We need to be objective and discrete , and we need to have an excellent poker face when necessary . What can go wrong ? As doctors , none of us are immune from having dysfunctional
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families , and sometimes in ways we ourselves can fail to recognise . There are always subtle and unsubtle power dynamics in any family relationship , which in cases of domestic abuse are malevolent . And things get missed when doctors treat their own . I ’ ve known cases of severe mental illness even to the point of suicide ; cases of cancers being |
missed because intimate examinations were not considered .
Yes , the medical board injunction can be inconvenient , and there are many apparently ‘ trivial ’ ailments that a doctor can deal with .
But it ’ s this injunction that prevents these trivial things from becoming unpleasantly complex . I was always taught that if you
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treat your own family you are either a bad doctor or a bad relative .
I can see why the roles are not compatible .
A doctor must be able to be objective , ask difficult questions , do difficult examinations , provide uncomfortable treatments , and to speak uncomfortable truths .
A relative should be there to provide love .
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I
STARTED my career as a rural proceduralist , and it was one of my mentors back then who informed me that , if you don ’ t treat your friends in a rural area , you don ’ t have any patients !
However , he did add the qualifier that , if you don ’ t feel okay doing a rectal exam for them , it ’ s probably best to refer them on to someone else .
His words returned to me when reading the recent debate in Australian Doctor about whether the Medical Board of Australia ’ s blanket injunction on doctors not to treat family and close friends outside of emergencies was over the top .
Dr Tony Trachtenberg , in his Australian Doctor editorial last month , understood why the rules were there , but he argued there were cases where treating family made sense .
He referred to those in rural areas where access to alternative sources of medical care was not quick or easy . And also cases where doctors needed to intervene because the care being provided was substandard .
But he also included examples that I believe are justified as they were emergencies — namely his father ’ s chest pain , collapse and arrest .
In the debate that ensued , some people asked for evidence that treating family led to a lack of clinical objectivity or risked discontinuity .
As a published researcher , I am confident that the level of available evidence is low because data is not deliberately collected , and the reason it is not deliberately collected is because it would be extremely hard to provide enough evidence of patient confidentiality to be accepted by an ethics committee .
I ’ ll put this bluntly . I am of the firm opinion that doctors should NOT treat their family , and that doctors and their family members should have their own GP .
Every medical consult should be a formal consultation with access to full medical records and adequate documentation .
It ’ s important that we all avoid the domestic version of the corridor consult .
I have trained as a parttime forensic medical officer , and I ’ ve seen some of the distressing aftermath when something goes wrong .
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