Article Figures & Data
Figures
- Figure 1
Interview guide.
- Figure 2
Factors that physicians consider when receiving medical requests from family and friends.
The first factor physicians consider is orientation to the situation (pentagon). They frame the potential consultation by asking the questions who, what, and where? Thereafter, physicians consider 5 interrelated factors (boxes outlined in bold). For each of these factors, specific considerations could lead to different outcomes: decision to agree to the request (dark gray boxes), decision to decline the request (boxes with dashed outline), or decision could go either way (light gray boxes).
Tables
Focus Group (Physicians) Physicians, No. Male, % Age, Mean (Range), y Experience as FP, Mean (Range), y Experience Before FMST Program, Mean (Range), y 1 (junior) 5 2 (40.0) 28.8 (25–33) – 4.0 (2–6) 2 (junior) 8 1 (12.5) 27.3 (26–30) – 3.0 (2–7) 3 (junior) 8 3 (37.5) 28.0 (25–33) – 2.5 (1–4) 4 (junior) 5 3 (60.0) 26.4 (25–29) – 2.2 (1–4) 5 (junior) 7 2 (28.6) 28.1 (25–31) – 3.0 (1–6) 6 (senior) 8 6 (75.0) 51.6 (48–57) 19.3 (14–31) – 7 (senior) 8 4 (50.0) 49.3 (40–63) 17.0 (9–25) – FMST = family medicine specialty training; FP = family physician.
Factor Quotation Orientation to the situation What is being requested? 1. “If it’s at a party, then the answer’s ‘no.’ At that moment, I’m not a physician, just a guest at the party. Unless, of course, that it’s something very serious, a life-or-death situation that I have to deal with. Otherwise, they need to go to their own physician or call me at another time. And then if it’s something really serious, I still advise them to go to their own physician.” [JP20, FG3]
Where are we? 2. “If I were talking one-on-one to someone face-to-face, at somebody’s house, and he asks me something, then I am much more inclined to listen, to have a look, or to listen further than I would if I were, for example, at a party. I don’t think that’s the time or place. I am busy doing something else. And neither do you have the peace and quiet to listen properly, so I am always much more circumspect in that sort of environment.” [JP25, FG4]
Who is making the request? 3. “So it has a lot to do with how much compassion I have with somebody whether I will say, ‘I’ll just draw that from my magician’s hat for I know the answer!’” [SP15, FG7]
Nature and strength of the relationship with the nonpatient 4. “If it were the neighbor’s wife, then I think it would be different. I think I would have said, ‘Your physician has examined you, so now wait for the results.’ But because it’s your own mother, you are therefore more worried, you go one step further. You travel that extra mile for your own family.” [JP22, FG4]
5. “For example, if you see a blemish and you suspect it is a basal cell carcinoma or something, with a family member or a good friend you are just not going to say nothing. You would say something like, ‘You should go to the physician because I don’t like the look of that spot you have got there.’” [SP15, FG7]
6. “You have the knowledge. And if I say to an IT expert, ‘Hey, have a look at this will you? My computer won’t work,’ you expect to get a simple answer. So I therefore thought that I should also be a bit more relaxed in my attitude. I have been more so over the past few years. With family too.” [SP12, FG7]
7. “Just say, you hear something from your father and you don’t say anything about it. Your father will then assume, ‘Oh, she heard it and has said nothing, so then it’s probably alright.’ So it’s a matter of my responsibility towards my family, but your family does expect you to do something if there’s a problem.” [JP27, FG5]
Amount of trust in one’s own knowledge and skills 8. “As long as I have no doubts. If I have doubts, then I would certainly just say go to see your own physician.” [JP16, FG3]
9. “I am conscious of this, because if I know that you probably are less careful in your examination, and that you probably don’t think it’s pleasant to contemplate that there could be something seriously amiss with a member of your family. And that you therefore would prefer not to go looking for something. So I am very aware … and thus alert to the situation. And I am convinced that if I am alert to what’s going on, it will turn out alright.” [SP4, FG6]
10. “Coincidentally, that happened to me recently. Someone had shaved her legs with a razor and sent me 3 photos asking me what she should do. And then I answered, very clearly, ‘I haven’t seen the full picture. I don’t know the whole story.’ This is the sort of situation that I keep myself well away from.” [JP2, FG3]
11. “Sometimes, I have a blind spot as far as members of my family are concerned. Things that I just don’t see or perceive as being less serious than they really are.” [SP11, FG7]
Expected consequences of making mistakes 12. “Things can sometimes just go wrong in the medical profession, but I would be scared of being blamed for this. I wouldn’t like to be blamed, let’s say, by a family member or a good friend. They are my close friends, and I enjoy a good relationship with them. And I want to keep it like that.” [JP23, FG4]
13. “You don’t want to have it on your conscience if, for example, you have taken a step backwards and therefore no action has been taken, and something serious is missed. With anyone, I mean a normal patient let alone a member of your own family. Then there’s also a level of personal involvement.” [JP30, FG5]
Importance of work-life balance 14. “Really, I would prefer it if, when I am finished with work, then I am really finished. I am then not very interested in examining people and so forth. I see being a physician more as a profession, not as my identity as a person. That’s what I hope to stay feeling and what I really want to be the case.” [JP11, FG2]
15. “I have certainly learned over time how to split the 2 roles in my head. As a family physician just starting out, you gave well-intentioned advice or you listened to the complaints of family members, then you recognize that the roles of family member and physician are interwoven in the words that you choose or the interventions that you carried out. Eventually, you become more aware of just what cap you are wearing at any given time.” [SP2, FG6]
Risk of disturbing the physician-patient process 16. “It is also good that the patient’s own family physician is able to keep tabs on things … So if I go ahead and sort out problems for people and they have, for example, the same trouble every month, the physician will be unaware that this is a recurrent problem each month … and loses the overview.” [JP25, FG4]
FG=focus group; IT=information technology; JP=junior physician; SP=senior physician.
The Article in Brief
Family Physicians Managing Medical Requests From Family and Friends
Esther Giroldi , and colleagues
Background Although it is discouraged, physicians regularly receive medical requests from family members and friends (non-patients). This study explores the experiences and attitudes of family physicians in training, as well as more experienced family physicians, towards managing medical requests from non-patients.
What This Study Found Physicians follow a complex process in deciding how to respond to medical requests from family or friends (non-patients). According to a focus group study of 33 family medicine residents and 16 senior physicians, physicians first orient themselves to the situation: who is this person; what is he or she asking of me, and where are we? They also consider the nature and strength of the relationship with the non-patient, their level of trust in their own knowledge and skills, potential consequences of making mistakes, the importance of work-life balance, and the risk of disturbing the individual's relationship with her/his physician. Senior physicians apply more nuanced considerations when deciding whether or not to respond; residents experience more difficulties in dealing with these requests, are less inclined to respond, and are more concerned about disturbing the existing patient-physician relationship.
Implications
- Although non-patient requests of physicians are common, they are rarely formally discussed. The authors suggest developing facilitated group discussions to help residents gain an understanding of and confidence in addressing such issues.
Annals Journal Club
Jan/Feb 2018: Managing Medical Requests From Family and Friends
Kelly A. Thibert, DO, Grant Family Medicine, OhioHealth and Michael E. Johansen, MD, MS, Associate Editor
The Annals of Family Medicine encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a RADICAL journal club. RADICAL stands for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. We encourage diverse participants to think critically about important issues affecting primary care and act on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article and provides discussion tips and questions. Take a RADICAL approach to these materials and post a summary of your conversation in our online discussion. (Open the article and click on "TRACK Discussion/ Submit a comment.") Discussion questions and information are online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Giroldi E, Freeth R, Hanssen M, Muris JWM, Kay M, Cals JWL. Family physicians managing medical requests from family and friends. Ann Fam Med. 2018;16(1):45-51.
Discussion Tips
This article explores the experiences of newer and more seasoned family physicians in managing medical requests from family and friends outside the clinical setting. Think about your time as a medical student, resident, and/or attending physician and recall your own lived experiences when a friend or family member asked for your expertise to help them medically. Consider if you would have handled those situations differently at various stages of your training.
Discussion Questions
- What question is asked by this study and why does it matter?
- How does this study advance beyond previous research and clinical practice on this topic?
- How strong is the study design for answering the question?
- What is a focus group? What are the strengths and weaknesses of focus groups?
- What is an inductive thematic analysis?
- To what degree can the findings be accounted for by:
- How physicians were selected or excluded?
- How the data were collected?
- How the findings were interpreted?
- The perspective or viewpoint of the analyst?
- What are the main study findings?
- Is there an ethical line physicians should not cross in treating nonpatients? Are there "grey areas" that are more acceptable?
- What similarities/differences are there between a nonpatient requesting an opinion from a physician compared to comparable requests of other professionals (ie, retirement planners, lawyers, etc)?
- What is your judgment about the transportability of the findings? How might the findings change across countries? Across specialties?
- What contextual factors are important for interpreting the findings?
- How might this study change your practice? Policy? Education? Research?
- Who are the constituencies for the study and how might they be engaged in interpreting or using the findings?
- What researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. http://annfammed.org/content/4/3/196.full.
