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It is only in recent time that physicians are not permitted to diagnose or treat self and direct family members (spouse, children and parents) for fear of not being objective. There is some truth to this statement, but the restriction causes unfairness and frustration to physicians with gravely ill family members, who typically turn to the physician in the family for help, to consult for diagnosis and/or relief of suffering.
For many professionals outside of medicine, it would be unthinkable to disallow them to help own family with their learned skills and knowledge. Unfortunately, it is considered misconduct for physicians to use their expertise and knowledge to help self or family members. No person can argue that a physician will care more about his own health and the health of his family than another physician.
Without jeopardizing the board definition of doctor-patient relationship, I propose that it should be permissible to diagnose self and/or family members if only non-invasive tests are used, such as blood test or imaging. Also, participation in treatments for self and family members should be acceptable as long as it is at the same time under the care of another physician as ‘chaperon’. Physicians treating family members should not bill OHIP for the service.
A blanket policy prohibiting a physician treating self or family members may not be the best option. One of my friends started an IV on her baby after 6 failed attempts by several others.
I agree the College’s policy is overly restrictive. For example, I see no harm in diagnosing and prescribing medication to treat my child’s otitis media (according to best practice guidelines) if it is 2am (or any other time) even if another physician is available to diagnose and treat. The inherent delay to get to a physician’s office (or the ER if the office is closed), get the prescription and then get it filled seems needlessly unnecessary and unreasonable. I think the child’s physician’s office should be called to let them know the diagnosis was made and the medication prescribed after the fact.
Furthermore, I’d see no harm in re-filling non-addictive medications (e.g., oral contraceptives, asthma medications, topical steroids, etc.) for family members as long as the original prescribing physician’s office was notified after the fact.
Frequently, despite best efforts and for a variety of reasons, prescriptions may not be transmitted in a timely manner from the prescribing physician’s office to the pharmacy.
I totally agree.
I do agree
I fully agree with you. Most of us would like to help our loved ones and we do not expect to be paid for such service.
Considering, how busy is our life, we should not be forced to consume our own and colleague time to obtain requisition for basic tests. We deserve some trust in us from our College.
There is nothing wrong with treating self or a family member by the physician. I do not agree with the Colleges’ excuse that treating self or a family member is against the mandate of the College “To protect the Public.” I am sure every one would agree with me that self or a family member is not public, rather me and my family.
Therefore, present policy should be left untouched.
I agree with comments of all others who do not want to see the present policy changed.
I agree completely. We should not bill for the care, but diagnosis and treatment of family is often reasonable. This actually saves OHIP money.
I agree with your proposal. I recently had a personal experience when I was about to be sent to OR with a misdiagnosis. For a simple condition I suffered around 2 weeks and was sent to different tests, and I could not convince that colleague that I had the same symptoms with my previous episodes. I think it is unacceptable to not be able to treat simple conditions of yourself and family and instead go through expensive tests and suffering for a long time while you are working for the health of the others.
I completely agree,that the rule is too restrictive. I find no reason,why a physician should not be allowed to treat his or her family members. We understand their needs better,that even close colleagues. We should be given the respect,that we can exercise good judgement and objectivity in our dealings. I am sure,that no physician will make a really important decision about a family member without consulting with a colleague,but the final decision could be left in the hand of the doctor of the family.
Prescribing opioid narcotics (except in an emergency) should not be permittetd and physiciand should not charge OHIP for the treatment of their family members.
I also agree that the rule is over restrictive for the same reason. The college talked about risks and the difficulty in being objective when we treat ourselves or our family. The issue is relative. In any doctor-patient relationship there are always objective as well as subjective elements. Can I treat someone who is not a relative but has taken care of me when I was growing up? Can I treat someone who has been abusive to me in the past? It is well known that there are jurisdictions outside Ontario where there is no explicit restriction on treating one’s family. Is there evidence that the quality of care has been compromised? In these days of evidence based medicine, I would like to see restriction of practice based on evidence rather than speculation. Like others, I am not opposed to restriction on prescribing narcotics and controlled drugs.
I fully support this statement.
Well made argument. I agree entirely.
I strongly agree
Because of the waiting times for appointments it does sometimes seem much easier to write a prescription for an antibiotic for an uncomplicated infection such as a conjunctivitis, otitis media, pharyngitis for a family member or possibly for a vaccination needed for travel. If getting appointments with physicians was easier particularly over weekends when it probably means hours of waiting at a clinic or ER, this would not be as important.
Totally agree with previous comment
We as Physicians could Diag and treat as “chaperones” of other colleagues: obviously not billing for the services.
I would add to the non invasive tests,the the prescription of not controlled meds.
In other words not allowing the prescription of controlled substances. narcotics, THC,
I think if a physician is qualified in any particular field he or she should be allowed to treat family members for even minor matters rather than having them see another physician. For a more significant condition, they should be allowed to institute some treatment and refer family member on to a qualified consultant. It would save the system money and probably stop a lot of needless M.D. visits.
The definitions in this policy are very vague. What are “minor condition” and “when another qualified health care professional is not readily available”? Is an otitis media a minor condition? We know that it may turn to meningitis. Can a physician prescribe antibiotics for his child with otitis media? How about vomiting in an 18 months old? If there is an open emergency room in the town, does it mean another qualified health care professional is ‘readily’ available? What if the waiting time is 3 hours? How about 6 or 12 hours? What if it is midnight? Where do we draw these lines?
The way I understand it, the policy intends to prohibit physicians from treating a family member for a condition requiring ongoing therapeutic relationship or a condition with immediate risk of morbidity or mortality where an emergency physician is available. If that is indeed the intention, then why wouldn’t we clarify the policy?
agree with all prior comments
I would like to see the Policy remain essentially unchanged.
However, I would like some clarification as to what is meant by the statement “Only when another physician is not readily available.”
I understand that all professionals and non professional get support and advantage from their organisations when they need help such us getting incentive , discount , helping their family who can not afford alawyer for example or buissness consultation , IT support , help their family get jobs and get them connected with work place so the have priority for employement except doctors .If I go to walk in or emergency I will have no priorities what so ever,even no respect what so ever which is so embaressing to be watched by family member or a friend. although I help and support patients and community at enlarge i am unable to be ahead in very few times that I need , usualy we are very busy and for doctor who has family and we should be able to help our family for emergency situition , why not , narcotics are not good to be prescriped to family or friend but otherwise I see no problem helping our family untill they can see their own doctor .
I’m confused as to what exactly constitutes ‘minor medical situations’ and where does one draw the line as to what are more serious conditions other than what is obvious. Also what are the guidlines for writing prescriptions for oneself or an immediate family member? A family member has some rosacea for which I used to have her apply metronidazole gel. Now my local pharmacist says I’m no longer permitted to sign that presecription for her medication. Is this true?
I wonder if these regulations are too restrictive and tends to infantilize the profession.
Current policy does not need changing — guidelines clear and concise.
!. What about other provinces?
2. Understandable to not prescribe own narcotics.
3. More efficient to have ability to order own x-rays.(non-invasive), or lab work and ECG`s.
4. As is said if not broken do not tamper.
I also believe the current guidelines are too restrictive. There are situations when acting on my own behalf or on the behalf of my spouse or child can improve their care, especially when there is an undue wait for services from their own doctors. Doctors also do know or should know the risks of the medications they prescribe for their patients, and so understand the risks for themselves. Of course, doctors should not be permitted to self-prescribe controlled substances; however, I believe that forbidding all prescribing is paternalistic.
The concept of do not treat ones family members arose under a different era, when professional courtesy ensured that our family members would be attended to, while we attended to others. Professional courtesy is rare today, The concept of do not treat family members arose at a time when house calls by doctors were common….they are no longer common. The concept arose when all doctors ensured 24/7 coverage for their patients. That is not a guarantee today. The concept arose at a time when doctors could get their practices and other professional activities covered while they as the primary family caregiver accompanied or transported family members to other doctors. That coverage is not easy to get today, without a lot of “begging” and “payback”. Having both elderly parents with neuro-degenerative diseases and a spouse, also with a neuro-degenerative illness, I can attest that there would have been medical disasters without my intervention as a physician. Much of that role occured as the “robotic arm or eyes ” of clincians who could not attend to my family, but relied on my observations to initiate care. Sometimes it did not. As a physician one must know ones limits and seek help whereever possible. But it would be unforgivable that I am giving devoted care to others, while my family risks falling through the cracks. Bottom line: it is immoral for me to place my loved ones in jeopardy when the system is not there for them!
To continue after you… The concept arose at a time, when professional courtesy was obvious and legal. Now, after affair in Alberta we are on our own.
I know very mature physician , who during the weekend ,was waiting for long hours in his hospital ER, to be finally admitted with severe sepsis. Then he spent days in hospital and recovering at home . Obviously he would do better if he would not hesitate to get his friend involved and receiving antibiotic earlier, but he did not want to expose anybody to possible conflict with the College policy… You can imagine, how many patients lost appointment with this doctor due to his unnecessarily prolonged illness.
It’s becoming fashionable to whip physicians and strip the profession of any left dignity and this will not bring more doctors to Canada.
It is overly restrictive to disallow physicians from treating themselves or immediate family members..I can see prohibiting the regular prescription of narcotives or other potentially addicting drugs as being proper. But diagnosing and treating simple and obvious conditions that fall in the area of the phsycians experise /training , repeats of simple drugs when they are for chronic use, etc should be allowed( as long as the patient is in the care of another physician).
I think the policy is well laid out and a good backgrounder. I would agree with: “For a minor condition or in an emergency situation” but without the second part requiring ” AND Only when another qualified health care professional is not readily available”.
As an emergency physician, I can’t imagine sitting in an emergency department waiting room to have someone examine my child for a “minor” but urgent medical conditions such as described by others, when the diagnosis and management is within my area of expertise. Perhaps a little more leniency for those physicians practicing within their knowledge and training for minor concerns would be appropriate. The example of antibiotics for AOM is a good one as I have never chosen to do this for my child, but if I choose NOT to treat with antibiotics and thus not take my child to their physician, is this considered “treatment”? It certainly could be.
For emergencies, I again, don’t believe you need the phrase: “AND Only when another qualified health care professional is not readily available”, if the emergency is within the skill set and training of the physician and it is more practical, quicker and medically appropriate decision. I would much prefer to put my family member is a splint after an acute injury and have them follow-up with their own physician during regular office hours than to plan an urgent visit to an ED or MD’s office out of hours.
I hope that we can be reasonable and allow minor and emergencies without the requirement of no other MD available.
I don’t see that there is great potential for harm or abuse in prescribing non- narcotic medications for myself or my family members. Examples of routinely used medications could include: antibiotics, antibiotic eye drops, oral contraceptives, sleep aids and anti-inflammatories.
I think appropriate constraints could be put in place to ensure that prescribing is appropriate and not abused.
Current wording, and practice seems fine to me
CAN BE RESTRICTED TO TREAT ONESELF, BUT UNDER CERTAIN CIRCUMSTANCES SHOULD ALLOW TO TREAT FAMILY MEMBERS ( IMMEDIATE FAMILY MEMBERS)
As a surgeon it should be up to the individual surgeon’s discretion if he or she can medically or surgically treat their spouse and close adult family members. A separate consent should be drafted and instituted.
a surgeon should never operate on a family member that much should be obvious. Minor acute conditions, or renewal of chronic disease meds is unlikely to cause harm, a surgical complication on the other hand could be disastrous to family relations
This has always been a tough area – physicians do not like to overload the healthcare system (for example, trips to ER for something that is easily dealt with otherwise (croup in the middle of the night needing medicine, for example) I agree that any physician who chooses to EVER treat a family member walks a fine line – clearer guidelines might prevent misunderstanding or abuse. They do also risk not having the objective clarity that they might otherwise have – but we could argue there are many situations where objective clarity might be in question (difficult or demanding patient, to name one example). Physicians do get left to make a lot of very difficutlt decisions – oversight and guidance are appreciated – to the degree they help us work in an ethical manner, not where they make us afraid of litigation or discipline.
I think a member of the public could use the policy in a vindictive way – ie if a physician makes a judgement that treating a family member, in a certain situation, is justified – the resulting disciplinary action might be overly punitive (ie a physician… LOST HIS LICENCE to practice for six months and numerous patients in his area lost access to a primary health care provider. In this particular situation, it was a vindicitve family member. If a physician makes an error in judgment that in no way compromises the care it gives his patients, there must be another way to deal with this – perhaps asking that physician to take a course in ethics, or to write some sort of document explaining what has been learned. etc etc..
If physicians can be trusted to treat the public, why should they be not be allowed to treat themselves or their family members.
If they may not be objective in doing so, who better know that situation better than themselves.
What if I were an expert in certain types of surgery, why should I let any one less experienced to operate on my family member ? Then who is going to just I am not better than any one else ?
I believe the system or policy should NOT be against any physician from treating themselves or their family members. The ONLY exception is to prescribe NARCOTICS to themselves
I commend our college for this forum. I believe physicians should be able to prescribe tests and medications other than narcotics free of charge to their family members but not to themselves when it is urgent or when it is simply convenient yet not extraordinary. The decision should be left to the physician and the litmus test that he or she should meet is that another physician in a similar situation would have prescribed the same medicine or test.
On occaison T prescribe non-narcotic meds for my wife and very occasionally renew meds (eg thyroid) if she is having trouble getting the renewal in a timely manner
I feel it saves her GP office time and effort
For family I will on occasion get appropriate imaging done
For more immediate and related family and select friends I will facilitate referrals (send a friend with obvious severe CTS to a plastic surgeon I know because he has been waiting months for a local surgical referral)
I consider this to be an expedition of appropriate care managed in other ways will take to long and cost more in time and hardship
I agree with most of what has been posted. I am actually more thorough and conscientious when dealing with a family member. I also often have a much better understanding of the background and impact of the illness than a non-family physician, and I am more than willing to take whatever amount of time is necessary. I believe we should bill for treatment of family members just as for any patient. If there is inappropriate billing, then it should be dealt with just as with any non-family member.
LIfeLabsI really hope the policy will address the “Ordering Lab (and other) Tests on Family Members and Friends”…and “Asking for Results of Lab (and other) Tests on Family Members and Friends”
This is not an infrequent occurrence for hospital and community laboratories – and it is always awkward to deal with individual cases and individual entreaties.
My views are in line with the College, with the exceptions:
(1) the appropriate examination should be done
(2) definition of minor conditions: should include no one can provide the care within the context of time.
eg weekend and my kids with Otitis media or Tonsillitis. I see nothing wrong with prescribing antibiotics
even though I can wait a few hours and have time seen in the Emergency for the same
Otherwise I concur with most of your policy, especially the section on prescribing narcotis and psychotropic drugs (as never appropriate)
Apart from the prescription of narcotics treating family members and people with personal relations does not compromise care rather it may offer better and timely care The addition of involvement of another physician agreement could put some restriction and safe guard Thank you
the patient including the family members of a physician should have the right who should treat them.the parents (including) of a minor should have the right to choose who should treat their minor children .self prescription (excluding narcotics ,cancer tratment and tratment of serous illnesses) should b allowed to an extent.we should not assume that all physicins are offenders or ignorat based on the violations commited by minority of us.
You don’t mention why this policy is being reviewed. What are the relevant issues? How has this policy failed?
After reviewing the current policy, I see no problems with it. It should be left as is.
writing a prescription for a spouse or child for an antibiotic for a sinus infection, topical creams for acne or continuing a prescription for the oral contraceptive do not seem to me to be potentially worrisome acts. I think being able to prescribe such minor medications just frees up the system to care for someone else – surely a desirable opportunity in today’s over crowded doctor offices.
I think the CPSO often times takes a too ‘holier-than-though’ attitude about these things.
Psychotherapy is an obvious and serious undertaking that should never be entered into with family members.
Ongoing assessment and treatment of chronic conditions is also not appropriate.
However, under certain conditions it is unreasonable to forbid physicians from ‘helping’ out a family member.
A family member who is on medication for gout and hypertension has a family physician who, notwithstanding has been paid $200 annually to provide this service, often does not respond to more than one request to renew prescriptions. As my family member is elderly and not able to drive, I sometimes renew his medication for him as a stop gap.
An child with a high fever and a bulging ear drum doesn’t have to go to ER after hours if a simple otoscope exam reveals an otitis that can easily be treated with a prescription.
These kinds of situations should be flexible and allowed.
This issue has been a major source of frustration. There are very few specialists in our area. The current policy means those I call friends who have chronic, severe musculoskeletal pain (there are several), are barred from obtaining care from me. Getting care for them from the scarce and overworked colleagues has been extremely difficult.
In one case I told my friend she had to make a choice: remain my friend, or become my patient, in which case we would have no social contact. This should not be necessary.
I assume the CPSO is not barring any MDs from donating a kidney or other spare parts to friends or family needing transplantation shown to be a match.
Rendering emergency care to self,family and friends if no other reasonable alternative exists should be acceptable.
Rendering medical care to family and friends, where no alternative is available, should also be permitted, but should not include the prescribing of opioids.
I do agree that there should be a good but practical policy for self treating and treating family members. ( for the rest of this email, I will use self treat for both).
The physician should know the risk and benefit of self treat. In a clinical perspective, the risk is minimal. The physician knows his/her own health better than any other physician. It may not be as objective but we should trust the physician to recognize it.
The benefit: it is less time consuming and more effective in time management ( time to use treating patient than wait in the family doctor’s office); less cost to OHIP; and faster turnaround time for lab test interpretation and the treatment can be more timely.
Of course, there should not be any unnecessary investigation (i.e. MRI for lumbar spine for low back pain ).
Absolutely, no Narcotic or habit forming medications!
I believe that there is room to relax the current policy.
In general I find the restrictions very helpful to guide me (and my extended family) in what is appropriate when it comes to treating family members.
I do find it helpful to be able to prescribe limited antibiotics (e.g. ear infection) and puffers for children; particularly if on vacation away from home but still in Ontario or evenings/weekends. I am so busy with my own practice it definitely makes it difficult to get my own kids in for things like prescription renewal.
I think an option to treat families members under limited circumstances with limited drugs should stay; I hope everyone is able to use this responsibly.
I agree -the current policy needs to be revised to allow for more flexibility with prescribing for family members. I do not see a problem in filling repeats. Even with addictive medications (narcotics/ benzos etc) some consideration needs to be made especially with situations relating to palliation or end of life care. In addition diagnosing and prescribing for common infections or minor conditions should be allowed for.
WHENEVER A POLICY MADE BY ANY REGULATORY BODY WITHOUT TAKING INTO ACCOUNT THE COMMON SENSE, THAT REGULATION WILL NOT BE FOLLOWED EVENTUALLY NO MATTER WHAT. I can appreciate the fact personal relationship may potentially harm the quality of care in managing a chronic illness or providing an invasive procedure.we need to find a balance where if a physician treats his or her loved ones for strep throat for example should not be considered misconduct.
I agree. with such long waiting times and difficult access to health services, I feel it is even unethical not to respond to family members or own needs for medical care.
We should be allowed to order tests, like blood tests and imaging.We should also be allowed to access results.
The policy should be clear on prohibition for prescribing narcotics or ordering invasive procedures.
I agree with the current policy. It should be kept in mind that physicians are respected health care professionals. As such, they are often turned to for advice as to treatment options and approaches, and this is not unusually in “urgent” situations. It is often difficult to obtain another physician’s assistance in such situations, for example during travel. My typical example would be a family member who develops an eye infection during a road trip. The family is in an unfamiliar location, and the most straightforward thing to do would be to approach and discuss the situation with the pharmacist at the local grocery store. Perhaps this could be considered an emergency. The physician writes a prescription for his/her family member and the eye infection resolves. We should not make any alteration to the current policy which would interfere with ethically-minded physicians performing this type of task for their family members, as necessary.
I Agree with the Colleges policy regarding treating Family members and Friends. This in no way precludes the Family from seeking their opinion regarding treatments given/offered by their own/other physicians.
Policies created by the College carry considerable authority – thus the policies must be very clear and unambiguous.
In my opinion this phrase:
“It is, however, generally acceptable for physicians to provide episodic care for minor conditions, because such care presents little risk to the individual receiving the care and, in the case of providing such care to family members, is unlikely to give rise to a physician-patient relationship. It is also acceptable for physicians to treat themselves or family members in emergency situations where there is no one else qualified to do so. The College considers this acceptable because the benefits of providing the required care in emergency situations outweigh the challenges posed by the personal relationship.”
Is NOT the same as this policy:
Physicians should not treat either themselves or family members, except:
• For a minor condition or in an emergency situation, and
• Only when another qualified health care professional is not readily available.3 Where it is necessary to treat themselves or family members, physicians must transfer care to another qualified health professional as soon as is practical. Physicians are advised that if they do not comply with this policy, they may be subject to allegations of professional misconduct.4
The first general comment states it is acceptable to provide periodic care for minor conditions, however the policy states this can only be done when another qualified health care professional is not readily available (what does readily mean), indicates that the care should be transferred as soon as practical and then follows it with a warning
I agree in large part with the current Guidelines where boundaries are reasonably well established around the level of care provided. Common sense should dictate when we are beyond the limit of Non threatening acute illness, when often no more than reassurance or minimal treatment is involved. As for Who and who should not be treated Within the Family group I think it not unreasonable to extend this to nieces and nephews, with of course the same limitations
It is completely acceptable in Europe for a physician to use his or her best judgement when it comes to treating family. I remember when my child was born there and required urgent care, stepping in myself(as there was no paediatrician or anesthetist in attendance, only gynecologists) and resuscitating the child. When my wife almost died because of a missed diagnosis, she called me because her attending physician was unable to find a vein to give her the antibiotics; I spent ten days of visiting daily and giving her the i.v. treatment she needed. We spend out whole lives using our best judgement of what is in our patient’s best interest; when I judge that it is not in my family’s best interest to participate in treatment, I of course would and should not do so, but when in my best judgment it is in one of my family member’s best interest, I am not allowed to treat in Ontario. This is bizarre at best. Whenever I meet patients for the first time in a prenatal interview, I tell them that I spend my whole life, every day, making decisions on the basis of “what would I do if this is my child or grandchild”. But when my wife recently needed medical attention, we had to drive for two hours to the ER, and then wait for eight hours for her to be seen. This was tremendously stressful and could have been avoided. When a family member has an ear infection, am I really supposed to send them to a walk-in clinic or ER instead of making a competent diagnosis and treating them? Let me be very clear: there is no room for physicians to prescribe controlled drugs for themselves or their family, and there is no room for a physician to treat him/herself or a member of the family is in his/her judgement this is not in the best interest of the person who needs treatment. We cannot legislate goodness. But we have to trust our physician colleague’s judgement when it comes to treating self and family. Right now this is regulated in very typical CPSO fashion: with words that are not clear: very much like our beloved OHIP preamble; in this case: “minor” – what is minor vs. what is not? and “if another physician is not readily available” – what is readily available, and what about the trust and comfort the family might have in that other “readily available ” physician. I believe that it is urgently necessary to change the approach the CPSO takes in this issue and to shift the responsibility to the clinical judgement of the physician. The idea that I am so emotionally overcome when my child has an ear infection that I cannot diagnose and treat competently, is both insulting and ridiculous. I saw the Head of the Department of Gynecology in a country hospital I trained in (outside Canada) perform the most amazing and high quality transvaginal hysterectomy I have ever observed. And: he performed it on his wife. There was nobody “readily available” who could have done it any better, and this was completely acceptable practice. I am not suggesting that this could be achieved by many of us, and I certainly could not do it. But it should be left to the physician to decide what is appropriate and where his or her limit lies.
This policy is good as far as it goes but it has inadequate discussion of issues related to treating personal friends, practice partners and ex-partners and colleagues with whom one has close personal relationships.
Please consider expanding this discussion as many of the above individuals may be much closer emotionally to the physician than more remote family members you have specifically mentioned in the policy.
I think physician should be able to treat self and family member. I understand that in some more complex situation every patient needs specialist opinion, but some one should be able to treat more simple conditions. In my personal experience and in many circumstances I had to wait in walking clinics or ER to be able to talk to a colleague to get a prescription or lab req for a very simple condition. I think it is time consuming and costly for both other patients and physicians.
It concerns me greatly that so many physician respondents on here fail to see how treating a family member, self or friend could potentially result in a harmful outcome and is inadvisable, either medically or personally if something were to go wrong. Judgement is often clouded by a personal relationship as the policy outlines very well. I agree that very minor conditions or renewing stable chronic disease meds is unlikely to cause harm, especially if it is after hours and the usual treating physician is unavaiable. But ordering even basic tests for diagnostic purposes could be potentially problematic, failing to fully consider a proper differential diagnosis is certainly a concern, most likely a complete history and physical will not have been done and follow up could possibly not be complete. Imaging studies will often pick up incidental findings which then need to be properly interpreted, communicated and investigated. Certainly documentation would be difficult in the absence of a proper patient chart. This is not at all the same as consulting a family member who is an IT professional as the consequences are obviously much more serious than a broken computer. Lets have some common sense people and a sense of professionalism.
I think this comment is particularly important and relevant because it exposes prejudice we have been consistently led to believe in: “Judgement is often clouded by a personal relationship”. As a practitioner of evidence-based medicine, may I please ask for the objective evidence supporting this statement?
Furthermore, we should only be concerned about situations where “judgement is clouded by a personal relationship” so robustly that the practitioner is unable to be aware of his/her clouded judgement and unable to act accordingly and guided through appropriate self-monitoring.
Common sense needs to be applied. As long as narcotics or controlled substances are not being used it should be OK to sel treat or treat family members. That’s what is done in the US.
Also I wanted to ask about feedback regarding treating colleagues/staff at the workplace ?
I think it is very important to allow flexibility and not pathologize this practice for the following situations:
1) Brief courses of antibiotics and NSAIDs
2) emergency prescribing-3 day supply of anything two times per year max
No routine prescribing of any psychotropic or opioid analgesics ever.
I strongly believe that doctors should be able to treat there family members – if the family members have no objection. That’s what we are trained for and if we are not able to help our family as a doctor who supported us through our long training. It also saves time and money as you don’t have to take time off from your practice to book appointments. I think most physicians know there limit when to consult there colleagues when needed.
I am not in favour of this policy by the College.I can think of many instances where a physician need to treat a family member in an emergency and where there is no facility available conveniently.To treat a simple cold and cough in a family becomes a misconduct seems ridiculous.
This policy should be clearly marked as an advisory. It should also state the hospitals and other institutions may not use the advisory as a basis to enforce its own regulations.
Invasion of privacy is required to enforce this as policy. CPSO is also at risk of condoning invasion of privacy if it allies this policy with hospitals which try to enforce it as a disciplinary measure.
In the hierarchy of regulations, other regulations for healthcare delivery have precedence over this policy. Protection of autonomy and privacy also has priority over this policy.
In assuming that the physician’s judgement is altered when treating herself/himself or the family, one also assumes that the physician’s judgement is constantly varied, say, among patients whom he/she admires, and whom he/she dislikes. I would suggest that such physician should not be allowed to practise.
If there are ulterior motives in all situations, be it a patient, or a family member, the situation is a criminal case, and is not in the juridiction of the College.
My understanding about the reason that medication requires a prescription is due to the fact that most individuals are not aware of indications, risks, side effect, interactions or contraindications associated with prescription medication. Physicians are largely aware of all this and most physicians can gain rapid to detailed information about prescription medication. It would seem to me that in isolated cases such as taking some CIpro on a trip south, renewing a lost prescription for a family member, treating an emergency condition that clearly requires a medication (e.g. acute gout) should be fine and seems to make sense to me. I would strongly discourage a physician to get into a long term treatment of a chronic condition of a family member or friend.
Clearly if a physician abuses the right to prescribe by self medicating with controlled substances, the issue is a different one and must not be allowed.
I do think it is practical in many instances for physicians to be able to prescribe for themselves.
I think it is difficult to make a blanket statement about this, but general principles could certainly be outlined and published.
The main problem with the present policy is that most diseases today are chronic and require long term management. Intervention in mild acute problems is given. I have heart disease and arrhythmia and bronchospasm and find it easy to manage this myself rather than bothering my family physician and certainly not another Cardiologist.
I am intelligent enough to know when another opinion is required and do so. However, prescription renewal, simple diagnostic testing, self prescribing of chronic medications and the frequent renewals does not require another physician. In my case I know more about the problem than my personal MD. I do however check in with him periodically to bring him up to date. I would never consider self prescribing of narcotics. If my wife requires an occasional cough syrup with codeine or an antibiotic, I see no reason to involve another MD.
The time and effort that another physician would spend, can be handled more efficiently if I do it myself.
I have a number of friends who work internationally (engineers, economists, etc0 some are former patients. Vey occasionally they will have to catch a plane on less than 24 hrs notice and may not have enough medication and their own physician may not be available on such short notice especially if it is a weekend. If it is not a narcotic, am I acting incorrectly by giving them a prescription? I always document it?
Agree that the College is TOO restrictive. Basic tests, prescriptions should be allowed. Perhaps psychiatric & narcotic meds could be an issue. On the other hand, when my wife was dying with a sarcoma I seeked help from other MD’s re pain/wound management in the home setting. I could write a book on being a health care provider & difficulties in finding “the chaperon/attending physician” in both Toronto & my home town. Epipens,antibiotic.Hrt,insulin,prescription,etc, renewals are all items that a competent physician should be capable of handling for his family. This can also be coordinated with a family MD if or when available.
I agree the ruling is far too restrictive. Like a comment submitted below, looking after my wife for 5 years before dying of cancer, I too was called upon to write perscriptions, order tests, etc when other heath care personnel were not available.Other health care workers just expect you to be available and assist when others are not on call or take too long to respond to the problem.
Physicians should be able to perscribe non-narcotic drugs for themselves;-for example antibiotics, anti inflammatory meds,etc and a copy of the script sent to their physician.
The present ruling needs to be overhauled and become more liberal.
I have been an Intensive Care doctor for 21 years, and apart from that I have a small private practice: me and my wife, and I want the freedom to prescribe an antibiotic occasionally. Last time I tried this a Pharmacist gave me a hard time until he consulted the Pharmacist Owner. What Family Doctor does not get into his own Sample Cupboard when he/she or a family member needs something? I don’t agree with someone organizing their own investigations. I don’t agree with a doctor prescribing a narcotic, a controlled substance, oral steroid,or any sedative, anxiolytic, or antidepressant drug.
Response in PDF format.
One assumes only under normal circumstances would this be in vogue.
In unusual or emergency situations naturally any Doctor would provide treatment,this guideline notwithstanding.
Current Policy too restrictive and severe .
No allowance at all for usual good judgment
I do believe that physicians should be able to treat themselves or their family members when the situation warrants it.
10 years ago, my little nephews were diagnosed with pneumonia, and I used to babysit them often. They were treated by their pediatrician with antibiotics and got better soon. However, when I developed a cough with fever and chills, my family physician treated me with puffers and sent me home, despite my history. I kept going back, and was finally passed onto a physician colleague who, without seeing my previous history, proceeded to give me the same puffers for a viral cough. By this time almost 2 and a half months had passed by, and I had also seen 2 other walkin doctors. After I argued that I needed someone to look into the possibility of pneumonia, a chest xray was done and revealed lung infiltrates. I was finally treated with antibiotics. Had I been able to treat myself with the same antibiotics, I would have cost the OHIP system a lot less money.
On a few other occasions, I have been asked to help my nephews with febrile seizures and choking on small objects. If a physician family member is close by, it stands to reason that they would be called upon immediately rather than calling 911.
The College policy is very restrictive and in certain cases such as these, it would certainly help if physicians can help themselves and their family members.
I trust that my family does NOT think of themselves as the PUBLIC if requesting an opinion from me after hours or when their own physician is not readily available. I agree that all family members must have their own PCP for ongoing health concerns and continuity of care.
The College and Society has entrusted us with the right to treat everyone else except family members? No one can argue the fact that I’ll be more careful and compassionate toward my own vs the rest of the public. That is a normal human reaction/quality…”Blood is thicker than the water” However, our involvement should be limited to basic clinical diagnosis without involving labs, radiology, etc, and we should not charge Medicare for these services.
I have read ALL comments on this site. In summary,almost all disagree with most of the College view of the subject except for recurring narcotic prescriptions. Some say they agree with it and then go on discussing significant changes they think are needed. I wonder how many said they agree with the policy and also do nor really agree with it .The College has a way of consulting and then dictating anyway, so this consultation is just window dressing. It is significant that the USA and Europe do not go that route. But then the College always had this Holier than thou attitude or tried to be holier than the pope.
I think one should be able to prescribe antibiotics and other Non Narcotic or Non Benzodiazepine medications for self and family members if their G.P is not available.
I think physicians should be allowed to treat family members for very common illnesses such as otitis media, asthma, UTI. I also do not see anything wrong with given prescriptions for non-addictive chronic medications such as oral contraceptives, antihypertensives etc.
I think the policy should be changed restricting physicians only to not be allowed to prescribe opioids or medications that are highly specialized such as chemo etc, but I do not see why the rest need to be restricted.
I agree that we should not be allowed to bill for treating our family members.
I have read and reviewed the present policy in regards to treating one’s self, family members and those with whom you have a close relationship.
I believe the present policy is thorough and appropriate.
A physician may treat “minor medical problems” and prescribe or renew medications as appropriate, but not for serious conditions unless emergencies arise.
A physician should not however prescribe controlled medications or psychoactive medications as outlined in the present policy.
I agree that requiring physicians and their families to seek medical attention when they have a minor problem they can manage themselves is a complete waste of time and resources. I had a severe hemorrhagic bladder infection recently, pharmacist would not fill my prescription for myself, couldn’t get in to my doctor’s office, first walk in clinic wait was hours (and I had to get to work myself!), second walk in clinic finally seen and prescription written one more hour later all the while in severe pain and risking pyelonephritis only to get a prescription exactly like the one I had written for myself 12 hours earlier. My spouse also had severe otitis externa for which I sent them to an ER and they were prescribed amoxil! Of course it got worse and I had to beg a colleague to double check and make sure it was otitis externa and give correct Rx, which is what I would have done in the first place 48 hours earlier and at no cost to OHIP. Common sense is needed. The system is already overburdened. Wholeheartedly agree that there is inherent variability in each and every doctor patient relationship and the physician needs to be trusted to treat when he/ she feels able to and to refer the patient on or “fire” the patient when he/ she is conflicted or “judgement is clouded”. Agree benzos/ psychotropics/ narcotics and surgery all should NOT be managed for self or family.
The current policy on treating self and family members errs in assuming that most physicians treating family will make bad judgements most of the time. That assumption is wrong, and the policy is too restrictive. However, the policy correctly notes that treating self and family does carry higher risk of certain pitfalls, but there is no reason, and no evidence, to proscribe it so generally and forcefully.
In fact, in our age of fragmented care, overcrowding and difficulties finding good urgent care, it may be advisable for doctors in some circumstances to be involved on behalf of the patients they know best – who are often their family.
I think the tenor of the policy ought to be that it is preferable for doctors and their families to have a regular unrelated doctor. But to take it to the level of a strong interdiction against treating your family not only infantilizes the judgement of physicians, but also diminishes the quality of treatment for many patients. In this discussion of risk, that too is a risk.
Rather than using such an overarching, demeaning and restrictive tone, it would be more appropriate for the policy to highlight the areas where treating self and family treatments is of obvious and significant elevated risk. These areas would include mood and psychiatric disorders, repeatedly prescribing opioid and psychoactive drugs, and making major diagnoses of long term import.
Doctors in small towns have forever been forced by circumstance to treat their friends as well as their “enemies” as patients. Frequently they also have their families as temporary patients. It has always been their duty to be objective and professional.
For all these reasons, the new college policy ought to be more specific in highlighting the areas of true risk, and allow for more discretion which is so much a part of every day and every case in real professional practice.
I fully agree with physician #67. I think we are being treated like immature individuals.Being a professional implies ethics judgement knowledge and intelligence. I think that I can decide if a member of my family needs my expertise or not.In my office or in hospital I can function rationally with judgement. As far as billing is concerned I feel that for any medical services that is given and appropriately recorded it should be billed period. If instead of waiting 2hrs for a flu shot I give it to a family member, I will see him/her take a history do the injection record it in the chart, and the immunization booklet etc.. all done according to the ohip requierements for paiement.
Agree with all what has already been said that the current policy is too restrictive. Can’t really add more!
The current policy is too restrictive. Physicians are trusted to use their discretion and the college needs to allow them to do this.
Unless you are in some small town there is always a physician readily available in the emergency dep’t or an urgent care. In these days of fiscal responsibility and health care dollars it does not make sense for a physician to send a family member to a walk-in for a ‘non-controlled’ medication that they ran out of, or to get a medication that they need for travelling, for example. Nor does it make sense to send a family member to the emergency dep’t or urgent care for say an ear infection – swimmer’s ear or otitis media that you can reasonably diagnose and treat. Similarly, if a family member twisted an ankle and you had imaging facilities in your building , you should be able to order an xray if you feel necessary rather than using the emergency dept facilities.
None of these should be billed, in my opinion and controlled medications should not be prescribed. But what if my father died tonight and my mother was overwrought with grief and couldn’t sleep with the funeral tomorrow – would it be ok to prescribe less than say 5 ativan rather than have her sit in emerg or urgent care in her state?
The College has to trust physicians to use judgement and discretion while setting forth policy.
The vast majority would not treat beyond their comfort zone or continue to treat if the condition was worsening. Nor would we treat,in my opinion, if it were serious unless we had no choice.
The patient can also notify their usual physician at their next visit of anything we do and I see no need for us to do this for minor treatments.
Finally, restricting all to restrict a few does not seem reasonable at this time in terms of governance or health care usage,
so I hope the College allows more discretion and see if there is any increase of incidents over the next few years
I agree with the above statement and the general consensus that the policy is too restrictive.
I agree with my colleagues most of whom feel the College policy is restrictive and unreasonable. Indeed as a factual matter I think it is simply a subjective opinion that is thrust upon the profession.
As long as care and thought goes into providing care and is wilful on the part of the patient ie family member College should not object. Otherwise they are encroaching on a patient’s right to find care that is appropriate or most suitable. I am not saying that doctors should care for family members; just that if they do then the College should have neutral views on it.
I fully agree with physician # 67.I think the CPSO should treat us like the mature professionnals we are.I think that we can make appropriate decisions about treating family members based on the age, type of situation (eg:lack of doctors) time saving (eg:flu shot in my office rather than wait and travel to another clinic) even geographical challenges (remote location).I alse believe that you should bill foe any medical service rendered and properly recorded as per the OHIP schedule of benefit.
I think the guideline provides clear information. In my urban practice setting it is relatively easy to follow. Certainly it is easier to practice this way. I believe it would be impossible in quite rural settings to avoid treating anyone you have or develop an emotional relationship with. I avoided rural settings to avoid being socially isolated for this reason. Perhaps the new guideline could acknowledge the necessity of treating friends in some situations. Most importantly training should reflect learning how to do this well rather than 100% avoidance. I have seen physicians with more experience than I navigate this maze with apparent ease – it should not become a lost art. For those in situations where they must treat friends or have no friends, fear of regulatory punishment is worsening their already difficult situation.
I think it is unreasonable for physicians not to be able to help our immediate family in need. I suspected for a long time my son had allergies to nuts, something his primary care physician did not want to refer him for. For a year, I waited for him to be referred to an immunologist, knowing fully that he could have an anaphylactic reaction with no back up medication at school or home. I had sent a bottle on Benadryl to school, something I would never even dream of doing to a patient of mine. His school refused to administer Benadryl in case an emergency came up. After a year of waiting, he was finally tested and found to be severely allergic to tree nuts. I thought a million times about referring him to an immunologist but stopped myself due to the college policy. My son had had to use epipen twice since his diagnosis. What I’d he had a reaction while waiting for his referral, who would be responsible and how would I ever forgive myself as a mother ??
Is there any good evidence that if physicians self-treat or treat family members, that they cannot be objective? If not, then abandon the current policy. It appears to be overly restrictive and based on false assumptions. Also, there are too many rules for doctors already. We don’t need this policy, let’s get rid of it.
Treating Self and Family Members has to be viewed in the context of what the general public does on a regular basis. Family members tend to treat each other, where every mother/father plays doctor at one time or another to the best of their abilities based on
their knowledge base and experience.
I would not think that there is a problem if, for example, a physician were to prescribe a small quantity ( 5 tablets) of sub-lingual ativan for a family member who has fear of flying and must fly. According to the CPSO policy, this should not be done.
It is not clear what you mean by communicating a diagnosis. As a reductio ad absurdam: If someone has an earache and an URTI and one says, “you’ve probably got an infection, you’d better see your Family doctor” , does this count as a breach of professionalism?
Often times a family member will say “I’ve got epigastric pain that’s worse after eating, with heartburn.It gets better if I take Rolaids” Would it be wrong to say,”It sounds like you might have an ulcer. Go and see your GP”. If investigations and treatment are done by the family member doctor then yes, I think it’s incorrect, but if they say that they think it’s a,b or c and you need to see a doctor surely this is not incorrect?
Otherwise I agree with the policy. I have been working with US medical students for about 10 years and the number of them that are prescribed psychotropic drugs (and narcotics on occasion) by close family members is truly amazing. The most common drugs are Ritalin or Adderal and the students think it’s fine and are surprised when I ask them about the suitability of this. A whole new generation of self prescribing doctors is in the pipeline.
I’m very glad that there is a clear policy in Canada. But some fine tuning :- what is communicating a diagnosis, what is a minor illness need to be clarified.– Also I think this should be emphasised more as part of the basic curriculum on professional behavior, maybe in the first term of medical school along with ethics.
I firmly believe that we are the best advocate for our family members and would exercise our utmost clinical acumen to assist them. Allowing us to provide care will reduce healthcare costs, medication error, failure to follow-up on lab results.
There was an incident in which one of the HCW’s young spouse (in 30’s) underwent surgery and chemotherapy. Three months post chemotherapy, had CEA level measured – went for the next follow-up appointment 6 months post expecting to hear everything is great see you next year. Unfortunately, the CEA level was extremely high and no one really follow-up until three months later. This particular HCW worked at the same institution where the spouse was treated, however, because of the rule that HCWs are not allowed to view the spouse’s file, did not look-up the results. This could have been avoided had the HCW been allowed to review the lab results of the spouse.
Some of us have relatives who live in second and third world countries, where access to medications, like metformin, anti-hypertensives , statins, anti-depressants,PPI’s, insulin, and other life saving medicines, are both difficult to obtain ,and when available, prohibitively expensive. These family members see their personal physicians in those countries, but rely on their family member(s) who are in the medical field, in North America, to obtain and send those medications to them.
Policies prohibiting these activities jeopardize the lives and health of these family members. I am not certain what the specific policy is, regarding this issue.
As I review this policy, I review how my feelings on this sensitive subject have changed over my years of practice.
The policy is good as it reads. The problem lies in the real world application. Initially I avoided mixing medicine and family because of my understanding of this policy and wanting people close to me to receive the best objective care possible. After a number of family tragedies where I felt powerless despite all my verbal attempts to advocate for loved ones, my opinion swung the other way. Then I realized I could not handle the burden, guilt, etc of an error from not being able to maintain my objectiveness on someone close to me.
Although for these reasons and more the policy is good, there needs to be a better way for us to look after our own. My physician colleague and close friend was aware of the policy when he asked me to be his physician and treat his depression. So was I, and it was the main reason I had to say no. I did what I could to get him to help and contemplated completing a Form1 on him, but he was not immanently suicidal. It was not an Emergency situation at that time. The repercussions of completing a Form1 on him as his friend or his physician were obvious to me.
One week later he committed suicide.
There are more details, but do they matter? There are more examples of missed opportunities to help loved ones, and that is what matters.
How can we begin to acknowledge that when there is a close relationship between a physician and person, there can be a healthy physician – patient relationship?
My idea of a healthy relationship with family and people close to me would be akin to having courtesy privileges at a hospital. As much input as possible without being the MRP.
The only change in this policy I could see that would improve it, would be if it was made clear that when there exists an emotional relationship or where one develops the physician should be considered the courtesy physician in the care of that patient.
I think this would make it easier for a physician to participate in the care of a loved one, with all the appropriate checks and balances in place by having a supervising or leading physician for the patient.
As a participating but not treating physician, the value of the connection to the patient can be preserved, without the harm. Objectivity can be maintained by the treating physician, not by the emotionally involved one. This reinforces the fact that we as physicians, family or not, are part of something larger. We are part of a team of caregivers out for the best interests of or patients and loved ones. With patient consent, the emotionally involved physician can give valuable input to the timely and proper care of the patient. Recognizing this strength in the guidelines would facilitate the documentation of the courtesy physicians role in the system, and the role in the care of the patient. It would allow recommendations or minor participation that is made to family to be documented on paper and sent to their MRP without the awkwardness that exists today.
The current policy (re treating and prescribing for self or family) is more than adequate and, if anything, excessively restrictive. Surely CPSO can recognize that physicians currently exercise excellent and professional judgment in these circumstances and do not need any more rules and regulations than already exist. Physicians are not children.
College of Physicians and Surgeons of SaskatchewanA person reading the self treatment document might possibly use the first page to justify providing treatment to family members for minor conditions, without considering whether another physician is reasonably available. The document contains the following on page 1:
It is, however, generally acceptable for physicians to provide episodic care for minor conditions, because such care presents little risk to the individual receiving the care and, in the case of providing such care to family members, is unlikely to give rise to a physician-patient relationship.
The limitation is on page 2:
Physicians should not treat either themselves or family members, except:
• For a minor condition or in an emergency situation, and
• Only when another qualified health care professional is not readily available.3
I would suggest that the first statement should be modified to state that it is only acceptable to provide episodic care for minor conditions when another qualified health care professional is not available.
That is also consistent with how I read the Code of Ethics.
Regarding comment #83, rather than allowing the limitations on page 2 to prevail, I’d suggest that page 2 be deleted, allowing page 1 to stand alone. The vast majority of physicians responding to this seem to be saying the policy is overly restrictive, and that non-controlled and non-addictive medications ought to be able to be prescribed to a physician’s family members.
An MD should be allowed and encouraged to treat self and family members when:
- there is emergency
- it will result in faster delivery of care
- it is the family member’s preference
- it is not a risky procedure/treatment
- the official doctor of the family member is informed/aware/in agreement
OHIP should be billed if the action involves a complete exam, procedure, evaluation, etc. exactly like it would happen in a hospital or clinic.
OHIP should not be billed when evaluation/assessment in incomplete, less than standard, unnecessary/redundant or when the medical act is an act that is usually taught to patients (ex. injections for chronic diseases unless patient would have otherwise required the presence of a nurse or an MD). The evaluation or medical act in such case would be reported in the patient’s chart, and the treating physician made aware and with his agreement.
There are situations where a family member who is a physician should be able to treat himself or a family member for minor problems such as Forgetting ones medication and on holidays or going on holidays and realizing that there are insufficient medications .Getting quick appointments with ones physician is difficult. A new acute illness on say a weekend or holiday could be handled by a walk in clinic or emergency at a hospital. it would be less of a problem if physicians left a another physician on call when they are off rather than telling a patient to go to an emergency. of a hospital. I wonder if there is way to track this perhaps through prescriptions? I think family members should be defined more precisley
1. Treating one’s own family including one’s wife for acute urgent or emergency care should not constitute professional misconduct.
2. Physicians should have the ability, at their own discretion, to treat themselves or their own family members in urgent, non emergency situations, where regular medical care is not available( walk in or family doctor) and where it would be unreasonable or inappropriate to use Emergency Services and where followup would be with their own regular physician at the next available appointment for continuity of care. Eg, severe acute pain and/or infection, non life threatening, at 10 pm, Monday night, perhaps Otitis Media (regular medical offices would be closed) which may necessitate the generation of presciption(s) including a short course of appropriate analgesics if necessary.
3. Chronic medical illnesses should never be treated by the physician unless it is acute or acute on chronic and the regular doctor is not accessible as per para 2.
4. The prescription of a short course of narcotic and or benzodiazepine prescriptions should be scrutinized by the pharmacist but not necessarily withheld if the situation warrants it. eg. Severe dental pain, late at night. Under no circumstances should repetitive or chronic self care be permitted.
I agree with poster #86. Physicians who can be trusted with the care of their patients should be trusted to use their talents to help their own family members as well, especially in today’s environment of long wait lists and inaccessible specialists. Narcotics should be uniformly exempted except in short courses and without renewals. But to lose one’s license for treating family members seems a bit drastic and unnecessary and even counter-productive here.
I agree that this policy is too restrictive. We should be trusted to treat family members in minor acute conditions like AOM, bronchitis or UTI and save the system trips to ER or walk-in clinics on weekends or after hours. Sometimes ordering tests for example x-rays to rule out fracture save us 8-10 hours waiting time in ER and help reduce unnecessary expense .
For practical reasons it could be allowed for minor ailments and non-narcotic drugs. Otherwise more burden will be placed on the time of the family doctors who are already in short supply.
present policy overly restrictive and inflexible goes agaist what i have seen in almost 50 years of practise
Does the College have evidence of harm caused by physicians ordering routine tests and everyday meds (not narcotics) for family members?
From a policy perspective shouldn’t the onus be on the regulator to prove harm caused by absence of regulation?
Why though? Doctors should and must treat and take care of any and everyone who is sick and go for help to them. Doctors should not turn away any patients no matter what. Rich or Poor, Young or Old, we are all patients. I totally disagree in this policy. If I have a family member I would definitely want my family member to treat me for several health issues. But for sure if it is an embarrassing issue I would go to a non family member. I think that, this should be allowed to the patients to decide whom we want to choose to be our Doctors.
1. Guidelines and restrictions are important, but repeats on chronically prescribed (non-psychiatric, non-addictive) medications for family is completely reasonable.
2. Being able to treat family for such things as otitis media, pharyngitis, UTI’s etc is also reasonable.
3. Even though I work in an academic setting, I have had to figure out my own care and diagnosis frequently as our system is not well set up to figure out non standard presentations. eg unusual drug reactions. This is no comment on my excellent MD’s. It is simply that they are overworked, exhausted and working within a system that does not cultivate this kind of care. It is one of the few advantages of being an MD.
4. I wish I had sutured my daughter’s gash out in cottage country- instead i took her a local hospital, where they did a lousy job. My training/skill was much better-so this policy meant she received inferior care.
Please reconsider the policy- it is too restrictive. At the same time it behooves us to continue our transformation of the health care system so that we are only called for family for relatively trivial or chronic issues. MD’s should not be paid for stepping in for self and family- that sets up a serious conflict of interest.
The Canadian Medical Protective AssociationAs you know, it is not within the CMPA’s mandate to set standards for the profession. As such, we will not comment on the specific principles enunciated in the Policy, Treating Self and Family.
The CMPA appreciates that the Policy encourages physicians to contact the CMPA for guidance in the section entitled, “Spouses and Sexual/Romantic Partners”. Specifically, it is stated, “For further guidance, physicians should contact the College, or the CMPA or other insurance provider.” The CMPA would prefer if this statement were amended to remove the suggestion that the CMPA is analogous to an insurer. In recognition of the fact that the CMPA is a mutual defence organization, and not an insurer, we request that the policy use more generic language such as “other professional liability provider” in place of “other insurance provider”.
It would also be helpful if the Policy recommended that physicians contact the CMPA for guidance in relation to other medico-legal issues raised in the Policy, including prescribing for family members, selftreatment and evaluating whether a particular individual would be considered a “family member” under the Policy. In this regard, the College may also wish to consider referencing in the Policy the CMPA’s article, “Building trust- What are the boundaries with patients?” (published in September 2011).
Board of Directors of Drugless Therapy - NaturopathyThe issue of treating self and family members is critical. The Board supports the principle of this policy and has no specific feedback at this time. We look forward to reviewing the policy, once revised.
College of Physicians & Surgeons of AlbertaResponse in PDF format
Thank you very much for soliciting the opinion of treating Physicians in the Province of Ontario on the policy towards treating self and family members.
Please be advised that the great physician Maimonides enumerated his conditions for treatment of family members 750 years ago. This policy has been and remains a guiding principle for Jewish Physicians over the course of the last 750 years. In order to alert the CPSO to the existence of these well-established practice guideline I have therefore taken it upon myself to elucidate some of the relevant material.
The Bible states, “Thou shalt not stand idly by the blood of thy neighbor”. Anytime, anyone, no matter who, can save a life and doesn’t he violates this prohibition. (Babylonian Talmud Sanhedrin page 73a). If one doesn’t save a life it’s as if he destroyed an entire universe. (Maimonides Laws of Murder Chapter 1:16).
Maimonides permits Physicians to treat family members and self in the following circumstances:
1. In the event of an emergency where no other Physician is immediately available.
2. In the event that the family member, i.e. treating Physician, is in possession of medical expertise that is superior to those Physicians in the community.
To this, we can add another general category of circumstances where, from a practical point of view, it is permitted for a family member, who is a qualified Physician, to treat members of the family. As you may not be aware, Judaism is a very time-sensitive religion and rigorous adherence to time-based performance of religious precepts. In a circumstance where an approaching holiday or the Sabbath pertains, members of the family, who are not well, would in normal circumstances forgo attendance at Hospital Emergency Rooms or crowded Family Physician’s offices assuming that they are even able to get an appointment on short notice, due to concerns that their condition would not be attended to before the advent of nightfall, which marks a new day according to the Jewish calendar. Rather than a family member jeopardizing their participation in order a religious holiday or Sabbath observance and/or not wishing to wait for up to 72 additional hours in to obtain treatment at an accredited medical establishment, a concerned family member possessing the requisite skills is strongly advised and permitted to render medical treatment to the ill individual.
Maimonides in his Laws of Mamrim, Chapter 5:6,7 states: “If there is no other Physician available in the vicinity, a son who is a Physician may even remove a splinter, blood let or perform any surgical cut on a father”. (Rema Code of Jewish Law YD241:3).
No one, of course, would expect a Physician to operate on themselves, although has been known to be done in the past. Likewise, the prescription of medicine for acute conditions with the exception of narcotics and controlled substances, on weekends and after hours is permitted. Likewise, if a Physician possessed the requisite skill and was required to operate on himself/herself because no other Physicians were available in extreme circumstances, such as in a war zone, on the high seas where no other Physicians were available or on a mountain expedition where he or she had fallen into a crevice, Maimonides would sanction such treatment. Elective surgical procedures obviously do not fall within this description. Finally, if a Physician is a ritual circumciser (Mohel), he is not only permitted to circumcise his own sons, he is religiously commanded to do so.
Tractate Kiddushin page 29a of the Babylonian Talmud states that: “A father is commanded to circumcise his son”. (Maimonides Laws of Circumcision Chapter 1:1). A father should not ask someone else to do it if he can do it himself (Gloss 1 of R’ S. Eiger to Code of Jewish Law YD260).
This is a brief summary of some of the laws and principles governing a Jewish Physician’s ethical obligations for the last 5774 years.
I trust that you will find the material contained herein of interest and assistance in establishing CPSO Policy guidelines for your upcoming statement on the treatment of Family Members and self.
It’s about fairness. Physicians may complain about this policy, but how about other patients who are NOT your family members and have no connections like you physicians? While other patients are still looking for a family doctor, you physicians can just use connections or give your family member priority over others?
In Europe physicians can treat themselves and their family members, it has been very helpful for my elderly parents and for small immunizations, prescriptions of labs and x rays, small sutures,
We still have a clear mind and are according our confidence to the colleagues but we can be good doctors for our relatives,
This law is ridiculous apart from the heavy drug prescription.
Please let us refer our family members and ourselves to specialists when needed , to x rays , routine labs.
We will follow the same rules as for the other patients.
This policy is extreme. it is such a lack of confidence on our good sense.
It has to be changed.
Why are doctors not allowed to treat themselves and family members? This does not make any sense at all.
It is absolutely ridiculous to have doctors waiting in line themselves or with their family for treatments at the ER or the Walk-In clinics, especially when our healthcare system is so overloaded already!
If doctors can be trusted to treat the public, then doctors can be trusted to use their learned skills and knowledge to treat themselves and their families too.
I believe that our doctors would use their best judgment in any situation, whether it’s family or the public. Therefore doctors should be allowed to treat themselves and their families.
I would like to see the rules relaxed a bit. Treating you child’s OM carries minimal risk of harm and frees up my time to treat others.
We can remain objective and I think it is a great time to modernize.
Ontario Medical AssociationThe Ontario Medical Association welcomes the opportunity to comment on the College of Physicians and Surgeons’ consultations on two policies: Treating Self and Family and Consent to Medical Treatment. We have not identified any concerns with either policy at this time. We believe that the policies clearly and adequately set out expectations for physicians. We are also comfortable that the policies direct physicians to appropriate legislation including the Health Care Consent Act. Our only suggestion would be to include references to relevant publications of the Canadian Medical Protective Association (CMPA) which provide physicians with very practical advice in navigating issues that may come up with respect to treatment and consent.
Thank you for–accepting these comments.
I am split on the policy. Part of me agrees with the above statements that physicians should be allowed to use their professional judgement with respect to treatment of friends and family.
However, I can understand the CPSO’s stance on this issue. I do not see their stance as restrictive. I would rather say protective if anything. If this cushion between your professional and public life is removed, your time outside of the clinic can potentially be be bombarded by medical questions/favors by friends and family members. In what scenarios will I decline caring for them and proceeding for care? Will I over treat/over test family and friends? will an expectation be developed by family and friends for their care by me and will they not see their GP now? Will I have adequate work-life balance when they are now intertwined? Where will I document these encounters with friends and family? What if there is a potentially poor outcome after treatment i.e. people have been using treatment of AOM as an example, but what if I prescribe an abx and an anaphylactic reaction occurs, are we prepared for that potential scenario or similar scenarios?