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Mar22
No good deed goes unpunished
We have all been approached by our colleagues, friends, relatives and acquaintances for medical problems formally and sometimes embarrassingly informally at social gatherings and even at road side berms or in the corridors. We usually hesitatingly oblige them although we know that we are not practicing good medicine. These encounters frequently lead to inappropriate treatment. In the socially related patients, very often an inadequate history or l examination is performed. Many acquaintances just barge in to the consultation clinic embarrassing the treating doctor who is midway of his consultation with another patient. The situation gets further compounded, when the treating physician has previously been in a subordinate position, such as a medical student, or a junior attending physician. This can often adversely influence the treatment plan of the younger physician. In such situations if the treating physician is not able to maintain the control of the medical management of the patient, the medical literature recommends to terminate the doctor-patient relationship. It is also important to keep in mind that the visits with the acquaintance patient may, paradoxically, take longer than the typical office consultation. The social, hospital, and practice issues will often insinuate themselves into the conversation. Thus it is a good practice to schedule them at times when they will not interfere with other appointments. The anxiety of treating such patients and our effort to be extra vigilant makes us begin to doubt our usual protocols. There is a tendency to want to change our routine. It is important that the treating physician continue to practice what he or she would do for any patient with a similar problem without beginning to doubt what has worked well for all previous patients.
Finally, there may be a strong temptation to discuss the patient’s ailment with colleagues or other acquaintances resulting in the risk of rising of the ethical issues of a doctor – patient relationship. There are some proposed guidelines for the treating physician which should make him ask the following questions before treating an acquaintance patient:

1. Can I remain objective in maintaining the doctor-patient relationship or is an inappropriate collegial rapport likely to ensue?
2. Do I have an excessive amount of anxiety that may jeopardize my ability to care for a colleague or friend?
3. Am I treating this patient in the same manner that I treat all of my other patients (e.g., with regard to history and physical examination, diagnostic testing, and treatment considerations)?
4. Have I carefully explained to this patient about the illness and the prognosis in the same detail that I would for a ordinary patient?
5. Have I clarified the boundaries of the prior existing relationship and made it comfortable for the patient to discuss freely, and to continue or terminate the relationship without sentiments of guilt or anxiety?
6. Can I maintain this patient’s confidentiality?
7. Can I always act for the good of this patient even if it means making decisions that may jeopardize the friendship?

Thus we should always try to ask these questions before continuing any doctor patient relationship otherwise there is a definite risk of causing avoidable medical errors and blunders, and our initial acts of pleasing our acquaintances will ultimately lead us to discover the truth in Clare Boothe Luce’s observation that ‘‘no good deed goes unpunished.’’


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