The "Casual" Patient is Still Your Patient

Most physician practices have a specific protocol for established patients, whether the physician has seen the patient once or for 20 years. The practice maintains a chart—either paper or electronic—with documentation of the patient’s history, medications, and examination notes. But what happens when a physician provides care for friends, family members, or employees? Physicians may feel that because they “know” a family or staff member—and may not provide care on a regular basis—formalities, like histories and documentation, are not as necessary as for established patients. This kind of thinking is risky because the “casual” patient is still your patient.

Family
The American Medical Association’s Code of Ethics discourages self-treatment and treatment of immediate family members for several reasons. These reasons include potential loss of professional objectivity, which can interfere with the care of the patient, and potential failure to obtain relevant—but sensitive—information because of embarrassment or personal discomfort¹. Consider this case:

Following a fertility procedure at a medical practice, the patient experienced heavy bleeding. When her Ob/Gyn husband was notified, he admitted her and operated, discovering she had lost almost 75 percent of blood volume. The patient stabilized following surgery, and the Ob/Gyn had his wife transferred to a surgical floor rather than the ICU. He stayed in her hospital room following the procedure and awoke at 4:00 a.m. to find his wife in distress. She experienced respiratory distress and died one week later.

A malpractice lawsuit was filed against the hospital, several nurses, and the fertility specialists. The Ob/Gyn was sued as a third party defendant by the other defendants in the case. A jury exonerated the husband and rendered a $25 million verdict against the fertility specialists. The nurses settled the case, possibly because pre-trial discovery revealed unwillingness on the nurses’ part to intrude upon the husband’s “care” in order to monitor the patient².

Physicians who treat family members may also be less likely to take a thorough history, maintain documentation, or refer to documentation prior to treatment. In another family treatment case, the patient, who happened to be the physician’s wife’s uncle, sued the physician after he received an injection to which the patient had a history of being allergic. The patient suffered anaphylactic shock and was taken to the emergency department. This patient was an established patient of the practice, but despite the familial elationship, a lawsuit ensued.

Employees
There are also issues for physicians who provide medical care for their employees, whether as an established patient or by informal consultation. Physicians examining co-workers may encounter the same sensitivity issues or embarrassing situations as those who treat family members, such as the awkwardness of disrobing or discussion of personal issues. Treating employees can also cause physicians to lose objectivity. For instance, if an employee reveals personal information to the physician in the context of a health discussion, could it cause the physician to think differently of the employee, either positively or negatively, in the workplace?³

Similar to treatment of family members, physicians may also be less likely to record histories and maintain documentation of patient encounters with employees. Consider this example:

A medical assistant working in an orthopedic practice askied one of the physicians for the hepatitis B vaccine. He agreed even though she was not an established patient. The physician obtained the vaccine from his drug rep and gave her one shot. The medical assistant then began caring for her father, who was near death from hepatitis B. She found out later she might have received the wrong vaccination and blamed the physician who gave her the shot. The physician had not documented the encounter and had no defense for a lawsuit.

Brandy A. Boone, JD
Manager, Risk Resource