What Could Go Wrong When Doctors Treat Their Own Kids?
Famed doctor and medical educator William Osler once said, "A physician who treats himself has a fool for a patient."
What, I wonder, does that say about us doctors who treat our own kids?
This past winter, my daughter got the flu. She was miserable: daily fevers, achiness, sore throat, stuffy head and nausea with a total loss of appetite.
We didn't run a flu test on her, which you can do with a quick nasal swab at a doctor's office. Since my wife and I are both docs, we were comfortable that her symptoms fit the diagnosis.
Our feeling was that the illness would run its course. There isn't a whole lot you can do for the flu. Tamiflu gets plenty of hype, but it's no panacea. The most important thing is to get plenty of rest and make sure you keep your body hydrated enough to combat the fevers.
Eventually, both my wife and I started to worry our kiddo wasn't able to keep up with the necessary hydration. On the fifth day, we decided it might be worth taking her to the doctor, just to get her assessed by some fresh eyes and to make sure we weren't missing anything.
The doctor made us feel like we wasted our time. "A viral illness gets better on its own," she told our daughter (and us).
"You're doctors! Don't you just treat your own kids?" several friends later asked.
Here's the thing: Yes, we do. What we learned in medical school, and from years of practice, makes my wife and me pretty comfortable treating our loved ones for run-of-the-mill stuff. But we both know the pitfalls and don't hesitate to seek help when it's needed.
There's a general rule against treating friends or family members. It falls into the realm of medical ethics — frowned upon but not illegal. Doctors' professional detachment and judgment can become clouded when we try to care for those closest to us.
Also, when we impose our doctoring on the people we're closest to, those patients are less likely to share confidential or potentially dangerous symptoms. An ethicist would say that patients treated by a doctor who is family or a friend do not have full autonomy, or the ability to make decisions for themselves.
It's a dark corner of medicine. Nobody I know talks about it much.
Still, nearly all medical parents treat their kids. There are many reasons, though it's usually for the convenience of not having to put up with what regular folks do: sitting on the phone, making appointments, dealing with copays and deductibles, waiting and missing work or school.
After our experience with our daughter, I was curious to see how other doctors navigate these waters. I asked several colleagues to shine a light on their practices with regard to their families. I promised anonymity to those who shared their stories.
One doctor told me about sewing up his young son's heel after it had been cut on some glass. "I gathered up supplies, and when I got home I stitched him up," he said. "Right as we were about to begin he asked, 'Dad, how long has it been since you did this?' While the true answer was quite a few years, the answer I gave was more reassuring to him. No harm befell him for my suturing efforts. He healed fine.
"Why did I do it myself?" he asked "I could. It would save time and money. It was in an area of his body that no one sees. I didn't do the same when [my other son] got lacerations on his brow and scalp."
Another colleague was worried that despite his kids being up-to-date with their booster shots, they still somehow contracted pertussis, or whooping cough.
He prescribed an antibiotic for both children to treat the bacterial infection, but he didn't test them for pertussis first. His curiosity got the better of him, so he tested the older kid, figuring if one had it, they both did. It came back positive. Oops.
Whooping cough is a big deal in public health. And the lab automatically informed the local health department about the child's positive test. That notification led, in turn, to a schoolwide letter telling parents about the case. Luckily, no other children were exposed because of my colleague's quick treatment. But he admits feeling sheepish about not having used the proper channels.
Reflecting back on my family's situation, you might be interested to know that even though my wife, son and I were all vaccinated against the flu this year, our daughter declined. At 14, she's old enough to make some decisions for herself. And, though we disagreed with her on this one, we decided to respect her autonomy and let her live with the consequences. (No, we don't give her a choice on mandatory immunizations.)
She told us she has decided to get vaccinated for flu next time around.
John Henning Schumann is a writer and doctor in Tulsa, Okla. He was recently named interim president of the University of Oklahoma, Tulsa. He also hosts Public Radio Tulsa's Medical Matters. He's on Twitter: @GlassHospital