The most important doctor-patient relationship
I have been away from the blog for a while again, mainly because I am not managing my workload very well. It's not that I am falling far behind, but with the two courses at Queen's requiring more involvement lately I have not managed to get on top of things enough to justify taking time to blog. In due time I hope to comment on a few health related topics, including pharmaceutical regulation (as mentioned in my last post), the language use in health policy, and the difficulty of too many career choices. However, I was home this weekend for Easter and came across a dilemma that I thought I should share immediately.
When I eventually become a doctor, I am supposed to "limit treatment of myself or members of my immediate family to minor or emergency services and only when another physician is not readily available" (CMA Code of Ethics, point 20). I understand this is to prevent conflicts of interest and other complications that can easily arise in this situation; however, I don't see how I will be able to shield my medical knowledge from becoming part of my interaction with these people. Although I don't intend to ever be a formal part of any of my friends' or family's healthcare team and I will never be the one actually treating them, I wonder if I am doing them harm or good when even discussing their health without knowing their whole clinical picture. Put otherwise: should I try as hard as I can to remove the doctor part of me from this interaction, or should I be as interested in their health as I would be if I was their doctor?
As I become more aware of common signs and symptoms of various pathologies, it will be difficult to not be reminded of them on various occasions when interacting with people outside of the clinic. When interacting with family and close friends, this problem may be compounded by the fact that I probably also know quite a bit about their health history. Considering we are always told in class that you should be able to make a diagnosis 90% of the time on history and physical alone, I SHOULD be able to diagnose at least some things having even limited pieces of these two types of information. What should I do with this information?
If a person close to me were to come down with something that I felt able to diagnose and recommend treatment for, I am not sure where I stand on my role. It is obviously best that I simply tell them to see their doctor or go to the emergency room. But what if their doctor comes to a different conclusion than I did? This doctor would undoubtedly know more about the whole clinical condition than I, and would therefore be better equipped than I, but I am not sure how comfortable I would be with simply agreeing with their decisions. Should I contact him/her and give my clinical opinion? At such a point, I almost become part of the clinical team because I am giving educated input to a colleague on their patient. Should I simply recommend that they ask for a second opinion? This would probably be good if the condition was chronic, but it may not be an option if the condition was so urgent that there was not enough time; also, there is always the possibility that the clinical situation could take a sudden turn for the worse while pursuing other opinions, and I may actually do harm by recommending such action. In short, I don't know what I would do in this situation. It's a good thing that I still have ages to think about it before I will know enough about medicine for it to become an issue.
In the situation that a friend or family member is perfectly well, but I recognize risk factors for a problem that could occur later on in life, I think my role is a little easier to define. Again, because of the fact that time would not be as much of an issue, I could easily recommend that they see their own physician- maybe with a few tips of what to disclose so as to catch the doctor's attention. However, our present healthcare system does not do a very good job at health promotion and disease prevention, and it may happen that the doctor is not doing all he/she could in this regards. In this situation, I think I would feel comfortable with actually recommending the appropriate non-medical activities to reduce risk factors (i.e. "you should exercise more"); for medical reduction of risk factors, however, I think the best solution would be to give them the recommendation to take to their own doctor to make a decision on (i.e. "you should ask your doctor if you should be taking low-dose asprin every day").
It's pretty easy to sit here at my computer and think of how I would deal with these situations when they are not coloured by any immediate emotions. However, this past weekend I didn't even think twice before discussing with a close friend/family member how I think they should manage their risk factors; the thought of that person eventually getting sick was so powerful that the fact that I didn't know their whole clinical scenario didn't even cross my mind.
When I eventually become a doctor, I am supposed to "limit treatment of myself or members of my immediate family to minor or emergency services and only when another physician is not readily available" (CMA Code of Ethics, point 20). I understand this is to prevent conflicts of interest and other complications that can easily arise in this situation; however, I don't see how I will be able to shield my medical knowledge from becoming part of my interaction with these people. Although I don't intend to ever be a formal part of any of my friends' or family's healthcare team and I will never be the one actually treating them, I wonder if I am doing them harm or good when even discussing their health without knowing their whole clinical picture. Put otherwise: should I try as hard as I can to remove the doctor part of me from this interaction, or should I be as interested in their health as I would be if I was their doctor?
As I become more aware of common signs and symptoms of various pathologies, it will be difficult to not be reminded of them on various occasions when interacting with people outside of the clinic. When interacting with family and close friends, this problem may be compounded by the fact that I probably also know quite a bit about their health history. Considering we are always told in class that you should be able to make a diagnosis 90% of the time on history and physical alone, I SHOULD be able to diagnose at least some things having even limited pieces of these two types of information. What should I do with this information?
If a person close to me were to come down with something that I felt able to diagnose and recommend treatment for, I am not sure where I stand on my role. It is obviously best that I simply tell them to see their doctor or go to the emergency room. But what if their doctor comes to a different conclusion than I did? This doctor would undoubtedly know more about the whole clinical condition than I, and would therefore be better equipped than I, but I am not sure how comfortable I would be with simply agreeing with their decisions. Should I contact him/her and give my clinical opinion? At such a point, I almost become part of the clinical team because I am giving educated input to a colleague on their patient. Should I simply recommend that they ask for a second opinion? This would probably be good if the condition was chronic, but it may not be an option if the condition was so urgent that there was not enough time; also, there is always the possibility that the clinical situation could take a sudden turn for the worse while pursuing other opinions, and I may actually do harm by recommending such action. In short, I don't know what I would do in this situation. It's a good thing that I still have ages to think about it before I will know enough about medicine for it to become an issue.
In the situation that a friend or family member is perfectly well, but I recognize risk factors for a problem that could occur later on in life, I think my role is a little easier to define. Again, because of the fact that time would not be as much of an issue, I could easily recommend that they see their own physician- maybe with a few tips of what to disclose so as to catch the doctor's attention. However, our present healthcare system does not do a very good job at health promotion and disease prevention, and it may happen that the doctor is not doing all he/she could in this regards. In this situation, I think I would feel comfortable with actually recommending the appropriate non-medical activities to reduce risk factors (i.e. "you should exercise more"); for medical reduction of risk factors, however, I think the best solution would be to give them the recommendation to take to their own doctor to make a decision on (i.e. "you should ask your doctor if you should be taking low-dose asprin every day").
It's pretty easy to sit here at my computer and think of how I would deal with these situations when they are not coloured by any immediate emotions. However, this past weekend I didn't even think twice before discussing with a close friend/family member how I think they should manage their risk factors; the thought of that person eventually getting sick was so powerful that the fact that I didn't know their whole clinical scenario didn't even cross my mind.
posted by csmith at
8:27 PM
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