The Physician Blind Spot
Why your friend should never be your doctor.
A few years ago, a close friend of mine met a guy who knocked her off her feet. It had been a while since she’d met anyone whom she really liked and she was deliriously happy, so much so that we didn’t see her for two months. By the time we did, she’d become both a rabid soccer fan and French bulldog lover, neither of which she’d been 8 weeks prior. But new love is like that, right? It can be all-consuming, blurring the lines of where your interests stop and your significant other’s begin (the mental healthfulness of this to be discussed at another time).
Besotted was the only word to describe her state, which was why when three months into the relationship he inexplicably stopped calling altogether, she went into an an depressed tailspin. Not outwardly: she was too proud to seem needy, so she refused to pursue him or even demand explanation. But privately, she fell apart. She’d lost her appetite completely, she confided, and was having trouble concentrating because her heart would race. She was sleeping 10 hours a day but woke up exhausted. Anxiety had taken over her life. There was only one faint silver lining to her breakup. “I’ve lost 10lbs,” she said grimly. “For whatever that’s worth.”
I was stunned. “You MUST eat!” I said, horrified. I’d courted a fair number of frogs myself, but she could not let a failed relationship impact her life this way! There were other fish in the sea, I assured her, including ones that didn’t refer to New York City as “En-Why-See” or cite Snow Dogs as their favorite movie. Nothing was more important than her health, I decreed, suggesting that some time away would help. Her high intensity work at the hospital was burning her out. A few days off, maybe a drive to Santa Barbara, was the R&R she needed.
She dubiously agreed and hung up.
A few weeks later, she called to tell me she’d found her way to a primary care doctor, who drew blood tests and found that her thyroid was overactive. “I’m hyperthyroid,” she said. Turns out what she needed was a pill called methimazole, and not a drive up the California coast.
This wouldn’t have been as spectacularly humiliating of a story if it weren’t for the fact that I happen to be an endocrinologist, a physician who specializes in disorders of various glands, the thyroid being a prominent one. I routinely diagnose hyperthyroidism in patients several times a week, and my friend’s post-breakup complaints were virtually textbook. How could I have been so blind??
In art, one of the first lessons taught is that of perspective. For a drawing to be realistic, the light source must be consistent and the point of view can only be from one place. The same object cannot be depicted from two points of view simultaneously, or it won’t appear real. When we look at each other — whether it be our friends, family or co-workers — we see through the lens of our relationship and often are unable to perceive the person from a different perspective.
For these reasons, physicians have long been cautioned against treating friends and family members, as far back as 1803, when English physician and philosopher Percival argued in his book Medical Ethics that professional and personal identities should be separated when it came to caring for family members. The American Medical Association recognizes that certain situations may not be avoided, it generally discourages physicians from treating themselves and/or their family. The American College of Physicians similar advises that doctors should not treat themselves, family members or close friends, and some hospitals even bar surgeons from operating on family members.
“Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered.” -American Medical Association, Code of Ethics
Despite these warnings, there’s hardly a physician out there who hasn’t caved to the pressure or desire to treat a non-patient family member or friend. In a recent online poll asking that very question, an overwhelming majority of healthcare providers agreed that they’d done so in the past. The reflex to offer curbside advice, write a prescription for antibiotics for a routine UTI when a friend can’t get a hold of their primary, or examine the ear of a cousin’s sick child is a very common one, is one that most people can’t ignore.
But doing so comes with risks: both interpersonal and even legal. When a physician is treating a friend or family member, they may fail to ask the sensitive questions that lead to the correct diagnosis due to pre-conceived assumptions or biases. The increased pressure to deliver top notch care to someone you love may lead to increased testing and imaging, which can end up paradoxically muddying the diagnostic picture. A negative outcome, whether avoidable or not, can tear apart the personal relationship between doctor and friend/family. In extreme cases, casual and undocumented care that was well intended could lead to unexpected outcomes that later become fertile ground for legal battles.
Love, as they say, is blind. It turns out that so are doctors, when it comes to the people they care about. It’s love that tempts physicians to step in when our friends and family when they are in need of medical guidance, and it’s trust that makes people turn to their physician friends or family members during times of medical crisis. But it’s precisely that emotional bond that creates huge blind spots and a dangerous lack of objectivity, and history has shown this to be deleterious over and over again. There are some situations where a medical friend’s intervention can’t be avoided, particularly in emergent situations, where jumping in is absolutely necessary. But for the most part, while relying on a friend or family member as your treating physician is convenient and easy, it’s never a good idea for either party involved. As your friend, I’ll tell you what I think really about your relationship, or whether it’s you or your boss who is actually crazy. I’ll go house-hunting with you and help you localize the source of that strange smell in your basement, even though it’ll probably end up being something gross and possibly dead.
But I’ll let my colleagues treat your thyroid.
