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Treating Friends & Family Members

Ahmed Rashid - 17 May, 2018

I sometimes wonder what happens when specialists are asked by non-medical friends or family members about conditions outside their specialty area. What happens, for example, when a cardiologist is asked about a non-cardiac problem, like a rash, a red eye, or depression? Do they have a go at answering even though it’s not really their ‘thing’? Do they remember anything vaguely useful from their medical student or junior doctor days?

Of course, as medical generalists, most topics are considered fair ground for us as GPs, and we can usually provide some useful advice or reassurance. Maybe that’s why we’re so often asked for medical advice by friends and family, whether directly on a phone call or WhatsApp message, or on a more casual basis, perhaps over coffee or even at a birthday party.

In a new Dutch primary care study, trainee and experienced GPs took part in focus group discussions about their experiences of treating friends and family. The trainees were family medicine residents, equivalent of GP registrars in the UK, and the experienced GPs were family medicine supervisors, equivalent of GP trainers in the UK.

A range of factors emerged as important considerations that helped participants decide on how to handle these requests. The first and central factor was defined as “orientation to the situation”. This involved answering questions such as: who is this person, what is he or she asking from me, and where are we located at this particular moment?

A number of other factors followed this. These included the nature and strength of your relationship with the individual, the amount of trust in your own knowledge and skills, the expected consequences of making mistakes, the importance of work-life balance, and the risk of disturbing the patient-doctor relationship. Whilst senior GPs seemed to apply quite nuanced considerations to their response, the junior participants experienced far more difficulties.

Overall, the paper highlights the considerable complexity of the decisions GPs make about treating friends and family members. Although GMC guidance is clear that doctors should avoid it all costs, this paper highlights that the reality is not as clear cut as this. As we so often see, the world of general practice lives in the shades of grey between the black and white of guidelines.

Ahmed Rashid

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