Treating Family and Friends: A Risk Management Perspective

Treating friends and relatives as patients can lead to malpractice litigation.  Physicians must carefully consider the particular circumstances presented before deciding to treat a family member, close friend or even an acquaintance. If the patient is injured as a result of your treatment, failure to make a diagnosis, or follow up on test results, even relatives may not hesitate to sue you.

Unfortunately, sometimes such relationships result in poor or inadequate medical documentation and disastrous results for the patient. What can you do to protect yourself and ensure patient safety? Here are some suggestions from our most recent Case Review:

• The quality of care provided to friends, acquaintances and relatives must be at least equivalent to the care provided to all other patients.

• Unfortunately, the records of relatives or friends are often poorly documented, if documented at all. Frequently, no record is made or retained. The failure to maintain a medical record for a patient is professional misconduct. If an injured relative or friend makes a complaint to OPMC, this could result in a misconduct investigation and even disciplinary action. Always document your care in an accurate, detailed and timely manner.

• You must always perform a thorough history and examination. Taking a complete history and performing a thorough physical examination requires that you ask all of the same questions and perform the same examination that you would for a patient who is not a relative or friend.

• It is important to listen carefully and respond to the patient’s concerns and questions, just as you would with any patient. From the patient’s perspective, he/she may not be open or comfortable, or may even be embarrassed, discussing certain information with you that could potentially be crucial to diagnosis and treatment.

• You should always discuss the treatment plan and costs in depth to avoid surprises. Even when you have not billed them for your care, relatives and friends who are injured often do not hesitate to sue. They may believe you won’t view the litigation as a personal attack because you have insurance for medical malpractice.

• The patient must give informed consent for invasive procedures. Always perform a thorough informed consent discussion of the risks, benefits, and alternatives to treatment, including not undergoing treatment, and the risks of the alternatives. Documentation of the consent discussion and the use of consent forms are important.

• When appropriate, make referrals to specialists or consultants. If the patient’s condition is potentially serious, you should actually make the appointment with the specialist or consultant.

• Follow-up of all tests and referrals to consultants must be as aggressive as with any other patient. Not charging a friend or relative for an office visit has no effect on your responsibility to follow up with the patient if he/she fails to obtain recommended tests or consultations. Referrals and discussions about the need to be compliant, and the risks of noncompliance, must be well documented.

• If the patient at any time indicates he/she feels pressured by you regarding the choice of treatment, or he/she pressures you to perform procedures which are beyond your skills, competency and expertise, you should respectfully decline to continue to treat that patient. When this occurs, promptly refer the patient to the local medical society or his/her insurance carrier to obtain the name of a competent professional or specialist. You must not succumb to patient pressure to provide treatment and care beyond your skills and training.

• Do not fear to upset a patient who is a friend or relative by adhering to the standard of care you must provide.

These thoughts are excerpts of a legal and risk management perspective written by Donnaline Richman, Esq., for MLMIC’s Summer 2016 Case Review, which you can view here. The publication includes the full version of this perspective along with two case studies that illustrate some of the pitfalls of treating family and friends.