All of us want to like our doctors. Certainly we want them to be intelligent and current with medical and surgical procedures and medications. But no one of us wants to face a doctor who is brusque, dismissive and ‘all business.’ We want them to look at us as a whole person, not a set of organs or complaints. In the best of all possible worlds, our doctors would be patient, caring, inquiring of our histories and families, beyond the genetic diseases they may have passed on to us.
Sometimes we get lucky. Sometimes, we don’t. A client of mine once complained to her internist that the specialist he recommended for an area outside his expertise was impatient, bordering on nasty. She said: “I looked up his medical credentials and I’m sure he’s very smart but he was officious and rude. So, do I stay with him?” The doctor replied: “You should have both a kind doctor and one with credentials. I’ll see if I can find you one.”
So, what happens if we find that caring and well credentialed doctor, and as our doctor/patient relationship moves on, we develop a mutual friendship? Perhaps we meet outside the office at parties. Perhaps we invite our doctor to our home and our invitation is reciprocated. With the change in relationship, how can we, both doctor and patient, maintain the proper perspective and distancing required to be objective? The answer is: It is very difficult.
One of my clients told me that her husband, a plastic surgeon, had constant requests for ‘lifts and tucks’ from their personal friends. He would see them in his office only for an evaluation and then refer them on to another plastic surgeon he trusted. She quoted what he had told her: “I would never operate on a friend. Just as I would never operate on my wife. A friend’s comfort in having me as their surgeon would not outweigh my discomfort. What if she didn’t like the outcome? Worse, what if I made a mistake and harmed her in some way? Nothing I’d want to do with any patient, but the friendship would further compromise both her and my objectivity.” Smart man.
All kinds of problems can result from a doctor taking care of a relative or friend in any but an emergency situation or where there is a minor ailment such as an abrasion or perhaps a child’s sudden earache. In the broadest sense, it compromises the patient’s care. A doctor needs to be circumspect, objective, and that will be much less possible if the patient is a friend or relative. The worst story I’ve heard from a client about what can happen when a doctor and patient have a friendship is the following: The gentleman in question went to his friend, an internist, who would not accept payment for his services, but in order to be compensated for his time, he billed the insurance company, providing a bogus diagnosis. It was entirely different from what the doctor told his patient/friend that he had, which was really…nothing. The gentleman decided to change insurance companies and when he did, the new company checked his medical records and came upon the internist’s ‘diagnosis’ and refused the insurance on the basis of a ‘pre-existing’ condition. Now, of course the doctor had committed fraud. But if the patient were not also a ‘friend’ to the doctor he might have reported him. However, he felt he could not… so he did not.
Doctors who treat friends and do not charge them, lose money. They are not like retailers or car salespersons who can offer discounts but are still remunerated for a goodly amount of the purchase price, and, therefore, do not lose compensation themselves. And, at this time in medicine where managed care pays doctors much less than they bill for, treating a friend without compensation compromises the doctor further.
To read more about the many reasons why medical societies have created guidelines for doctors treating family members or those with close relationships please see: http://www.acpinternist.org/archives/1999/01/relative.htm
In my body tuning practice I have many clients who have also become friends over the years. This makes it more difficult for both the client and me for the reasons I’ve stated about doctors and patients. I have to be vigilant so that treatment and socializing do not overlap. So I request from my client and demand of myself the discipline to be totally quiet during treatment so that I do not take my attention from the body problems I am trying to remedy. As many of my clients know, if they begin to talk, I will request that they remain silent during the session. When it’s over, clients are usually quite relaxed, in less pain, and not in the mood to talk, anyway, which means that I have done my work well and they are responding to the treatment and not anything else. This said, there are also situations where I will refer the client/friend to another practitioner in my office or elsewhere in order to keep the boundaries between friendship and treatment.
There is yet another issue I have discovered through my clients and from my own experience over the many years I have been in practice, which is that when a client wishes to have a referral from a doctor, whether it is for a physical therapist or another physician, the doctor will often refer the patient to a practitioner with whom he has a business relationship, in other words they refer patients to each other. But, a better approach might be to ask the doctor to whom he would refer his own mother or his wife. It may, of course, be the same person, but chances are it will not be. If your doctor is a real friend, he will refer you to whoever is the best practitioner in his personal experience.
A client came to see me after seeing three orthopedists who were her friends. Two recommended surgery for her knee problem. The third recommended physical therapy, and said she would need to devote at least 4-5 months to getting better. This was a great deal of time for her to consider as she is a professional woman and her time is limited. The doctor gave her a list of physical therapists from which to choose. I was not on the list as I had no business relationship with the doctor. She went to several physical therapists, and not being satisfied, asked a good friend to recommend her own physical therapist. The friend recommended me and the woman came to see me. She told me that having seen several other therapists, she now had the experience and could determine that I was the one to finally help the painful problem in her knee. Clients need to be willing to take the time to find out by personal experience, who is best suited to take care of them, just as this woman did.
It is important as you search for the best physician for whatever ails you to keep in mind that it is in your own interest to consider whether the practitioner can be objective about you and your problems. If you keep friendship out of the equation you won’t have to worry that your treatment may have been compromised by the blurred lines between medicine and friendship.