By Doug Brunk, San Diego Bureau
Dr. Anthony L. Suchman was the on-call resident running the medicine side of a hospital emergency department one night when the wife of one of his good friends walked in complaining of abdominal pain.
She required a pelvic exam as part of a proper work-up. Despite feeling ill at ease, he proceeded with the exam.
"It was awkward for both of us given that we were friends and knew each other in that social context," recalled Dr. Suchman, an internist in Rochester, N.Y. "We both knew that exam had to be done. But there was also the sense of being responsible for my friend's wife. If I didn't know her, I wouldn't have had any trouble going through the work-up and making a determination of what was going on. But there was this extra level of responsibility, or fear of regret, or fear of who knows what because we were friends."
It's a tricky business having friends as patients. Dr. Suchman likens it to other dual roles one assumes in life. In providing medical care to friends, "I take extra care to make sure I'm doing everything I would do as a physician who did not know the person and not back away from anything. It's the same thing you do when you have a doctor for a patient."
He explained that this extra sense of vigilance is needed because of the tendency to view friends in a positive light. "There might be certain things about them that they wouldn't want to tell us [physicians] because we're friends—about certain high-risk behaviors, for example. Or there may be certain things about them that we would want to deny seeing out of our loyalty to them that could obstruct our judgment."
Dr. Suchman makes it a point not to provide medical care to very close friends because he considers them adopted family members. And he strongly believes that physicians should not provide medical care to members of their own family.
Another point to consider: What if you make a medical mistake with someone who's a really close friend? "How are you going to feel about that?" said Dr. Suchman, who also chairs the board of directors for the American Academy on Communication in Healthcare, a group that promotes relationship-centered communication in medicine (www.aachonline.org
For physicians willing to take that risk, he advises having a chat about informed consent during the first office visit to discuss what the risks might be. Ask questions such as, "Will you feel comfortable disclosing everything to me? Are you going to be afraid of how I might judge things that you tell me?"
As he sees it, the best way to care for a close friend is to refer them to the best physician that you know. But if you practice in a rural community and you're the only physician in town, "you don't really have a choice. You may have to be their doctor."
A Deeply Rooted Trust
When Dr. Eniko K. Pivnick's 5-year-old daughter Lilla required eye surgery to correct her esotropia 12 years ago, there was no doubt in her mind that she wanted her close friend and colleague Dr. Natalie C. Kerr to perform the operation.
"It was very good for my daughter, because we knew her," said Dr. Pivnick, a pediatric geneticist at Le Bonheur Children's Medical Center in Memphis. "It took away anxiety for her."
Make that for mom, too.
Dr. Kerr and Dr. Pivnick have published medical research papers together, written book chapters together, and cared for patients together at the medical center for 5 years. "We trust each other professionally," said Dr. Kerr, a pediatric ophthalmologist at the medical center.
Even so, when Dr. Pivnick first asked if she would perform the operation, "I told her that my partner could do it if you're uncomfortable with me doing it," she said.
But no, Dr. Pivnick wasn't interested in hearing about any other option.
On the day of Lilla's surgery, Dr. Kerr asked her partner to assist with the procedure. That's a role she normally reserves for ophthalmology residents, said Dr. Kerr, who also directs the residency program in ophthalmology at the University of Tennessee, Memphis. "I felt like I would be more comfortable. Once we got started, it was just like any other case. Once you get the drapes on, I think it's pretty easy as a surgeon. Unless you come up with a crisis situation, I think it's fairly easy to be objective, do your job, and then you're done."