Friends and Family

Have you ever been working in the emergency department and someone asks you a personal medical question for themselves or one of their family members or friends? Have you ever gotten a text from family or friends asking for a prescription? For the first episode of Season 9, our hosts, Drew, Tanner, John, and Andy, tackle the conversation around advising/treating friends and family in and out of the ED.

In most cases, we are approached by friends, family, and coworkers because they are having trouble navigating outpatient medicine, they work odd hours and cannot get a reasonable appointment, or sometimes it’s just out of proximity and convenience. Many of us went to medical school because we wanted to help people. Here are some helpful tips for how to do that when the people we are trying to help are not formally our patients.

Set Boundaries

One of the most important things you can do in these situations is set boundaries. You have to decide what you are and are not comfortable with. Some physicians have a hard and fast rule of not prescribing medication or giving medical advice to anyone who is not a registered patient. Others will weigh the ask and will offer to help if it seems reasonable. Regardless of what you choose, try to remain consistent in how you go about helping to maintain good relationships. Certain things should be an absolute no like controlled substances and some things should be rare like represcibing recurring prescriptions.

Triage Appropriately

If you are going to treat friends and family, you must triage appropriately. If you do not have the necessary resources or the problem is too complex to be addressed without further workup, you should direct the person to the ED or their PCP depending on the concern. The key here is to treat and triage your friends and family the way you would if they were patients in your ED. Remember to be humble and admit when something is out of your scope or you do not feel comfortable. 

Develop Documentation

Different physicians have different methods, but it is advised to develop a secure method for documentation if you are going to prescribe medication to friends and family. Documentation is important from a medicolegal standpoint and is generally good practice. In most states, you are technically required to have a patient-physician relationship with someone in order to treat them and one easy way to show proof of that is by briefly documenting the encounter. It doesn’t have to be incredibly extensive. It can be as simple as screenshots of text messages, along with the person’s name, what you prescribed, how much, and the indication. Something else to consider is whether or not you have malpractice coverage for practicing medicine outside of the department. Some employers will cover you for that, others will require you to have separate malpractice insurance. 

Maintain Approachability

Finally, you want to make sure that in all of these interactions with family, friends, and coworkers you are being honest and informative. You want to work through the question or problem with them, similar to how you would with any other patient. The last thing you want is to leave the person feeling like they wouldn’t want to come to you again for advice.

Take-Home Points:

• Set boundaries up front.
• Treat friends and family the way you would treat your patients. 
• Be consistent.
• Refer patients to their PCP or the ED when you don’t have the resources necessary to care for them or you feel uncomfortable.
• Develop a system for documenting these encounters
• Maintain approachability

Post by Patricia Capone, DO PGY-3

References:

1. https://www.stemlynspodcast.org/e/five-free-strategies-to-improve-your-resuscitations-simon-carley-at-stemlynslive/
2. https://blog.impraise.com/360-feedback/the-power-of-peer-coaching-5-tips-to-improve-your-teams-performance
3. https://hbr.org/2015/03/how-to-get-your-team-to-coach-each-other

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