Helen Robinson: Treating family

HAVING a relative who is unwell can be a challenging experience for a doctor.

My dad recently died of metastatic melanoma. During his illness, I experienced many difficult situations, which I’m sure were not unique. My experience made me think about the unusual role of physician-relative and how best to manage the situations that doctors can face.

Physicians are known to struggle with objectivity when they take a history from a relative, often either under- or over-interpreting symptoms.

Before his diagnosis, Dad told me about his unusual symptoms. Although I did not take a formal history, I gave my opinion as to what the symptoms meant. Because I was emotionally involved, I never wanted to hear anything that suggested sinister pathology.

I didn’t ask questions to identify “red flags” and I convinced myself that Dad's symptoms were benign. As a result, I may have falsely reassured him. The potential delay in seeking objective medical advice may have adversely affected his prognosis.

I have always agreed with British and American guidelines, which recommend that doctors do not treat their immediate family. I didn’t appreciate, however, that by giving my opinion, I was, in effect, providing treatment. I should have recommended that Dad see another doctor immediately.

When Dad did see another doctor and a management plan was initiated, another problem arose as I disagreed with a crucial part of the plan.

This situation is known to be complicated for physician-relatives, as it tests the boundaries between personal and professional roles. I didn’t know whether to call the doctor and request a change of management, change the management myself, ask a medical friend to change the management or get a second opinion.

Articles addressing this issue have suggested that physician-relatives ask themselves: “What would I do in this situation if I did not have a medical degree?”

This is good advice as it removes the more controversial options that aren’t available to non-doctors. I chose to get a second opinion, which was the right thing to do in the situation. Dad’s management was changed and I hadn’t become professionally involved. I simply acted as an advocate.

One doctor, with Dad’s consent, sent me a copy of Dad’s scan report. It stated that the finding was most likely benign. However, there were features consistent with something more sinister. Dad had only been told that the finding was most likely benign.

I was then in the awkward situation of knowing more than my Dad and the rest of my family. While it is often tempting to obtain as much information about a relative’s illness as possible and particularly reports or laboratory results, it can actually make things more complicated and cause more stress.

When Dad was in hospital he often felt more comfortable telling me about new symptoms than his treating doctors. Deciding what information to pass on to the treating team was difficult as I felt like I should filter out what I believed were irrelevant concerns.

In retrospect I probably should have passed on more information than I did — just as we shouldn’t have information our relative doesn’t have, we probably shouldn’t have information the treating doctor doesn’t have.

Other physicians who have experienced the role of physician-relative have described it as “harrowing” and at times “terrible”. I agree with these sentiments.

I found work stressful as sick patients reminded me of my sick father. I found home stressful as I had become the family medical spokesperson and adviser. I felt that I had to stay calm and not show I was upset, otherwise my family would think the worst was going to happen.

It is important to recognise that the role of physician-relative is known to be stressful and to look after yourself accordingly.

While it is a difficult role, there are positive aspects to being a physician-relative. I enjoyed being able to help Dad through the medical process. He appreciated having someone there who understood “the system”.

I also now have a greater appreciation of what my patients and their families go through and I hope this has had a positive impact on my work.

I think the best advice to lessen the stress of the role is to decrease your professional involvement. See yourself as a well informed advocate rather than your relative’s doctor.

Also remember that the role is known to be difficult. You will be much better placed to help your relative and your family if you remember to look after yourself.

Dr Helen Robinson is a medical registrar in Brisbane.

Posted 8 October 2012

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