Should the doctor in your family be involved in your care?

I am constantly hearing from many sources that doctors shouldn't treat their own family members and friends when asked to do so. Can anyone provide data or evidence for this? I see "ethical" guidelines about this from state licensure boards, and medical societies. My malpractice insurer says it increases risk too. My two cents: I am aware of absolutely no evidence for these "ethical" guidelines. I'd like to see a single study of this question worth anything or any date, from a malpractice insurer or otherwise, showing that worse outcomes occur when trusted family member physicians, whom a patient wishes to be involved, are involved in a patient's care.

Here's a call to action for all my former academic colleagues at Johns Hopkins, UCSF, etc. How about some evidence-based patient-centered care? Why not do a study of whether people treated by family members, or whose family member physicians are involved in their care, have better or worse outcomes? As a profession, why do we assert something we have absolutely no evidence for besides our own prejudices? For those of you who do have a good clinician in your family whom you trust, wouldn't you consult them when you're ill?

In our practice, we assert in our tag line that "everyone needs a doctor in the family" (www.myadvicedr.com). We believe that on average, people benefit from having someone they trust, who is accessible, involved in helping them choose providers, compare treatments, and help them make sure that planned procedures or treatment are really the best thing for them.
It is my aim to be just like the doctor in the family whom you trust would be. So I definitely believe that trusted doctors in the family are a big help.

I'm willing to be proven wrong, but show me the data!! I would assert that we should not make blanket assertions without evidence as we are doing now in our state boards, medical societies, and malpractice insurance companies. How about some effectiveness research?

And meanwhile, I will continue advise my patients and others: If you have a trusted physician in your family, by all means continue to call them up and ask their opinion about everything you can. Until I see the evidence, I'm going with my gut. And if you can show me some evidence, I'll promptly post it the next time I blog.

Is it a good idea to see family members right after surgery?

I and a friend visited someone who had surgery today. Her closest relative (listed by the patient as her agent for health care decisions) had driven an hour to visit her in the recovery room as she woke up. When the family member arrived, she spoke with the surgeon. The surgeon said the patient was still asleep in the recovery room, and that the relative should go home and come back tomorrow because the patient needed to rest anyway.

When we arrived, we found the relative and her husband in the lobby, seeming anxious. The relative shared with me that she didn't know what to do because she was unable to visit the next day as she had taken today off work and was unable to take another day. She was very concerned that everything had been planned incorrectly because she had taken off today, but the patient had been in surgery all day today, and now no one would be visiting tomorrow. I reassured her that I would visit tomorrow and that other friends would as well. However, I was concerned that the surgeon had sent her away, as I believed from my conversations with the patient earlier in the day that she had very much wanted to see both her relative and me that night when she woke up. The relative then spoke to the patient's elderly mother on the telephone. The mother was also very upset that no one would be there when the patient needed it. The mother spoke to me, and I told the patient's mother to try to get some rest and not to worry. I told the relative to wait and that I would go back to see what was going on.

I went back to recovery and discovered that the patient had just gotten up. I asked the recovery room nurse if I might visit with her briefly, and he agreed. I smiled at her and she smiled back. She said she was in no pain, and had patient-controlled analgesia (a pain medication pump allowing her to give herself as much pain medication as she needed within limits). I then asked the patient if she wanted to see her relative, and our other friend, who was out in the lobby. She said she would very much like to visit with her relative and with her other friend and me for a little while.

I went to get the relative and brought her back to recovery for a few minutes. We then waited until the patient was moved to her regular room, when we, and the other friend, were able to visit with her for a half hour. We called the patient's mother and had the patient speak with her to reassure her that all was well. A friend called and we answered the phone for her and relayed good wishes (the phone was placed in an unreachable location to the patient, who was bed-bound due to a urinary catheter). We told jokes, and the patient laughed and felt happy to have friends and family around.

I was so glad that I prevented the important bad outcome of the patient waking up to no friends and family, as well as the relative and her husband going home distraught not even to have been able to speak with her, the patient's mother worrying all night without speaking to her daughter, while making possible the warmth, friendship and humor that the relative's and friend's visit provided.

Surgeons, please do not project your own exhaustion after the surgery onto the patient and/or the family who have come specifically to see and support the patient! If there are no medical issues which are preventing the patient from waking up after surgery, do not send family members home before the patient wakes up from recovery because you are tired, even if it is late!! Please encourage family members to stay and be with their loved one for at least a few minutes when they come out of recovery and get into their rooms. It makes a world of difference to all concerned.

Family members need to be assertive!! You can ask your relative what they want when they wake up in recovery and then get transferred to their rooms. You will find out if they want you to see them or if are they the type of person who abhors being seen without their (take your pick) face on/dentures/glasses/wig/toupee/clothes. Most of the time, you will find that despite having scanty and ugly hospital gowns, urinary catheters, no teeth, etc. they want to see your lovely faces! And once they let you know this, do not let anyone, even the surgeon, talk you out of it, unless there are medical issues that are preventing your relative from waking up.