Family, Friends and Employees as Patients

Doctors periodically provide clinical care outside of chiropractic maintenance care to their family members, friends and employees.

Posted in Risk Management on Friday, January 4, 2019

Good intentions motivate providing care to family, friends and employees, but consider how difficulties may arise:

Scenario 1—Grandchild as Patient

Rob Sutere, D.C., was on vacation in the Caribbean with his daughter and grandson. His daughter came in from the beach carrying her two-year-old son, Toby, who was crying. She told her father that Toby had been unable to settle down for the last hour, and she thought he might be getting an ear infection.

Dr. Sutere took a look, and saw no redness or swelling of the eardrum, so he didn’t think it was an ear infection. Instead, Dr. Sutere believed Toby probably got seawater in his ear and was overtired. The child was put to bed and stopped crying within 15 minutes. Later that night, Dr. Sutere’s daughter went to check on Toby. She found he had vomited, was shaking and could not be aroused. She called her father who noticed the child was also having difficulty breathing and was feverish.

They called 911 and Toby was taken by ambulance to the local hospital. Upon arrival, the child suffered a seizure, and the ER doctor found a large red and inflamed welt on the back of Toby’s right ear.

Toby had been stung by a jellyfish and had an allergic reaction to the venom. After receiving prompt treatment, Toby recovered with no permanent auricular damage.

In this scenario, the doctor did his best considering he was out of his realm and close to the situation.

Scenario 2—Employee as Patient

32-year-old Sara Johnson was at work as a CA when she told Derrick Anatole, D.C., she had been having sharp abdominal pain on her left side, as well as nausea off and on for the last 36 hours.

Dr. Anatole asked Sara some routine questions and determined that her last menstrual period was 7 weeks earlier, but that she had always been irregular. He had her lie down on an exam table and palpated her abdomen but was not able to evoke a specific pain response.

Dr. Anatole told Sara that she probably had a gastrointestinal bug. He sent her home, telling her to force fluids and get some rest. The next morning, Sara did not report to work or call in sick. After several attempts to reach Sara by phone, the office manager called her sister—Sara’s designated emergency contact—and told her that the office had been trying to reach Sara but had been unable to do so.

Unfortunately, when her sister went to check on her, she found Sara dead in her bed. An autopsy revealed a ruptured ectopic pregnancy.

Dr. Anatole didn’t view this as a patient encounter—just as helping an employee. However, it became apparent that Sara perceived Dr. Anatole’s suggestions as clinical advice, and his actions would not have been able to be defended in the event of a malpractice lawsuit.

Issues with Family Members and Friends

• A doctor treating a family member/friend may find it difficult to maintain professional objectivity and clear clinical judgment.
• The personal relationship may make it challenging to obtain a good history and perform a complete exam (e.g., asking sensitive questions about sexual topics, domestic abuse or drug/alcohol use). This can produce a doctor/patient encounter that does not meet the standard of care.
• Past clinical records, medication lists, and other information may not be available or reviewed. Proper documentation of a clinical encounter between a doctor and a family member/friend is rarely present.
• Doctors may attempt to render care outside of the chiropractic standard of care in their quest to help.
• Due to the personal relationship, a relative/friend may be reluctant to question the doctor’s recommendations or to ask for another opinion.

Issues with Employees

• Employees may be hesitant to share sensitive information, be reluctant to question the doctor’s treatment recommendations or to ask for another practitioner’s opinion.
• If a doctor decides NOT to document sensitive information to protect it from being discovered by other employees, the note would be incomplete.
• Hasty hallway consultations could establish a doctor/patient relationship that may not meet the acceptable standard of care.
• Employees should not receive special treatment. They should be seen during regular office hours when they are off-duty and be afforded the same HIPAA protection as the practice’s general population.
• Be careful about providing care for on-the-job injuries. Should the employee file a workers’ compensation insurance claim, the doctor’s treatment may be considered a conflict of interest. In these cases, it’s best to refer the employee to a trusted colleague.

In general, it is best to avoid informal consults with family, friends or employees (as well as colleagues). Politely advise them that you cannot provide optimum care without a complete history and a physical examination. If appropriate, ask the person to schedule an appointment at your office.