A Doctor’s Reflections on Being a Patient and Patient Advocate

After almost 40 years as a physician, with a career as an emergency physician, quality-assurance reviewer, and medicolegal consultant, I have finally retired. Surprisingly, I still spend a fair amount of time searching and reading topics in UpToDate. Like many physicians, I get a lot of requests for medical advice and evaluation of medical care from friends and family. Retirement has not put an end to this. Friends are getting joint replacements, cancer, and other illnesses, and I am now having some of those same ailments as well. Some of the care has been excellent, but unfortunately there have been some distressingly bad outcomes.

As a physician, how should one relate to the medical system when you are not the one providing care? Most of us have been told not to act as our own physician or the physician to our family. There are medical, medicolegal, and interpersonal risks in doing so. The AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members advises against it.1 Nevertheless, most physicians do not follow this dictum.2 In the real world, it is not so clear-cut, especially at the margins. If you are not going to be the treating physician, how should you interact with the physicians caring for your friends and family members? I could find nothing in the medical literature on this topic. Personally, I was never taught how to navigate these dilemmas, so I have had to learn the hard way. These are the lessons I’ve garnered through experience.

An orthopedist, for example, has little business opining on the care of a family member with an ST-elevation myocardial infarction, unless the care is egregiously inappropriate. Yet they can still become involved in the routine aspects of care as a highly educated layperson. As someone who was board certified in both internal medicine and emergency medicine, my lane has been fairly wide. However, the farther I get from the centerline, the more circumspect I have become. The very last thing you want to do is disrupt good medical care.

Most laypeople make their own decisions when to seek medical attention for themselves and their family. Until that time, they treat themselves, rightly or wrongly. Physicians do the same thing, just with a lot more medical knowledge. It is convenient and efficient and often effective to handle simple or clear-cut things yourself, but be aware that your medical decision making is often impacted by affective bias, where your feelings about the patient impact your decision making. Often, I have made good decisions, but many times I have not.