Is a doctor treating a family member with dementia an AMA ethics violation?

Question

Let's say I have a family member with dementia (let's call him Dave), and his mother's husband (not his father, let's call him Bob) is a neurologist. Dave's father had the same issue with dementia, and after he talked to Bob, he was prescribed some medication that worked really well in slowing down the progression of the disease, so we think that if Dave also talks to Bob, it would also work. Is it an AMA ethics violation Bob to give Dave medical advice, or prescribe medication? Is there a way for Bob to talk to Dave without violation? This is in Utah, United States. By AMA, I mean the AMA Code of Medical Ethics.

Answer 1

There's nothing inherently unethical about treating a friend or family member. However, the AMA recommends against it for other reasons:

When the patient is an immediate family member, the physician’s personal feelings may unduly influence his or her professional medical judgment. Or the physician may fail to probe sensitive areas when taking the medical history or to perform intimate parts of the physical examination. Physicians may feel obligated to provide care for family members despite feeling uncomfortable doing so. They may also be inclined to treat problems that are beyond their expertise or training.

Similarly, patients may feel uncomfortable receiving care from a family member. A patient may be reluctant to disclose sensitive information or undergo an intimate examination when the physician is an immediate family member. This discomfort may particularly be the case when the patient is a minor child, who may not feel free to refuse care from a parent.

In general, physicians should not treat themselves or members of their own families. However, it may be acceptable to do so in limited circumstances:

(a) In emergency settings or isolated settings where there is no other qualified physician available. In such situations, physicians should not hesitate to treat themselves or family members until another physician becomes available.

(b) For short-term, minor problems.

When treating self or family members, physicians have a further responsibility to:

(c) Document treatment or care provided and convey relevant information to the patient’s primary care physician.

(d) Recognize that if tensions develop in the professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.

(e) Avoid providing sensitive or intimate care especially for a minor patient who is uncomfortable being treated by a family member.

(f) Recognize that family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician.

Item (c) is where I suspect things are most likely to go wrong. Does Dave have a chart opened on Bob at his place of business? If another physician reviewed that chart would they find it to be complete with an exam, medical history, etc? If another doctor calls his office with questions about Bob, will Dave's staff know who Bob is and be able to provide answers?