Is there a doctor in the house? An analysis of the practice of physicians' treating their own families

THE PRACTICE of physicians' caring medically for their families is not new and appears to be common. In the only published empirical data on this subject,183% of 465 practicing physicians in a community teaching hospital had prescribed medications for family members; 80% had diagnosed illnesses; 72% had examined family members; 17% had attended family members in the hospital; and 11% had operated on family members. Most (59%) had previously refused a family member's request for medical care; 48% had referred the patient for whom they had made their "most important diagnosis."1 Incidence, quality effects, process and outcome of care, and the utility and effectiveness of the physician-patient relationship when physician and patient are family remain unknown. The practice of physicians' treating their own families raises ethical concerns, including when to breach confidentiality or obtain advance directives; how to secure informed consent, assess decisionmaking capacity, or give end-of-life care;