A Doctor’s Dilemma: Treating Family Members as Patients
Should we treat patients like our family — or treat our family like patients?
Recently, guest blogger Kristina E. Hoque, MS, MD, PhD, shared a poignant story with me about a personal experience. Her conflicted feelings inspired the following introspection that she has graciously agreed to share with our online JACR community.
Treat each patient as if they are your family.
We hear this wisdom taught in medical school classrooms, whispered in ward corridors, and echoing in our own heads. We know and feel what this wisdom is meant to evoke, what this phrase is meant to inspire. Rarely do we pause, however, to meditate upon what might happen if we were to actually treat each patient as a member of our own family. I remember when I was first taught this, in my first year of medical school, before I became a wife and a mother.
A certain calm, polished, calculated demeanor is the sign of a seasoned doctor. While the casual outside observer might mistake this for simple callousness, this carefully sculpted approach to patient care is deeply multidimensional and allows the delivery of impeccable medical care. In pivotal moments in patient care, irrational emotions rarely result in productive therapy.
The ability to calmly keep one's own sense of sadness, grief, or even joy in careful check allows for the patient to be at the center of care. And while a doctor can deeply experience the range of emotions felt by the patient, these emotions are carefully processed internally. Over the years of medical school and residency, we learn when it is appropriate and safe to cry with patients and when it is fitting to celebrate with them. Yes, we keep the patient at the center, at the heart of our actions and reactions, but we are guided by reason, evidence, and years of training.
Emotional intelligence and disciplined control are ingrained in us, but our limits can be tested. What happens when the patient is literally a member of our family? What happens when the person before us is our parent, sibling, or child? Whether we're asked for casual advice at the dinner table or to interpret a formal staging CT, we may all face a situation like this at some point in our career. Common sense warns us to simply avoid treating family. However, the lines we imagine should never be crossed are often blurred, bent, and crossed in real life. Perhaps the best approach we can take is to treat family as if they were our patients.
I have found myself navigating this uncharted territory between family" and "patient. I've come to realize that those two very precious titles are often not mutually exclusive.
In our everyday work as radiologists, we wouldn't allow irrational emotion to trigger a biopsy of a benign incidental finding on the very unlikely chance that a cancer is present. We don't allow our judgment to be swayed to avoid a potentially painful but necessary procedure. We offer the best possible advice based on available evidence, within the context of each patient's specific situation. We owe it to the people most dear to us, our families, to offer the same excellent care that we provide every precious patient every day.
Can we approach the care of our loved ones with the same calm, polished, calculated demeanor of a seasoned physician? Will we allow a family member's experience to set the tone of the moment and appropriately modulate our own emotional response? Will reason and experience guide our actions? Do we know when it's OK to just cry? Although quite difficult, in the pivotal moments of my family's medical journey, treating my family as I would my patients is perhaps the most loving act I can provide.
I aim each day to treat each consultation, be it at the dinner table or in the reading room, as if whoever is being discussed is my patient. Perhaps the greatest lesson I've learned as a doctor is to treat everyone as if they are my patients, rather than treat everyone as if they are family. As a daughter and a wife and a mother, who also happens to be a doctor, I know that the most selfless way I can provide excellent patient-centered care is by treating each person — family or not — with the same art of caring that I continue to sculpt on my journey through medicine.
Thanks to Dr. Hoque for beautifully stating what's in her heart and on her mind. I hope we can use the opportunity of reading her message to spend a few moments contemplating how challenging it can be to balance both sides of ourselves as health care providers. We cannot separate the side of us that is a cool, competent, sophisticated professional from the side of us that is just as emotionally and cognitively vulnerable as any other person in times of a family health care crisis. However, we should deliberately prepare ourselves for the inevitability of such situations. That way, we can deal with our families with as much clarity of thought as possible so we don't risk hurting them. We must couple this with a commitment to maximize their dignity with our unconditional love and support, while allowing other colleagues the challenge and honor to work on diagnosing and healing the people we love.
Please join Dr. Hoque (@KristinaHoque), JACR Editorial Board member and past ACR RFS Education Liaison and Alternate Councilor, along with the rest of the JACR tweet chat team at noon Eastern time on Thursday, June 23. Hoque will be guest moderating a discussion about ethical and practical dilemmas when family members become patients.
We will discuss the following questions:
T1: If we are taught to treat patients as family, how do we treat our actual family members when they become ill?
T2: What ethical and practical issues arise when we interpret the imaging tests of a family member?
T3: What can we do if we disagree with the care our family receives?
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