A physician receives a phone call from his sister requesting an antidepressant prescription for her 16-year-old son. She explains that he saw a psychiatrist who prescribed the medication for depression a year ago. The boy has been doing well on the medication and has not seen the psychiatrist for more than 6 months. She is concerned that the psychiatrist will be unwilling to refill the prescription without seeing him for a follow-up appointment. The sister is reluctant to schedule an appointment due to cost and inconvenience and asks the physician to do her this favor. As far as the physician knows, his nephew has no medical problems and does well in school. He was unaware of his nephew's history of depression until now. Which of the following is the most appropriate course of action?

Question

A physician receives a phone call from his sister requesting an antidepressant prescription for her 16-year-old son.  She explains that he saw a psychiatrist who prescribed the medication for depression a year ago.  The boy has been doing well on the medication and has not seen the psychiatrist for more than 6 months.  She is concerned that the psychiatrist will be unwilling to refill the prescription without seeing him for a follow-up appointment.  The sister is reluctant to schedule an appointment due to cost and inconvenience and asks the physician to do her this favor.  As far as the physician knows, his nephew has no medical problems and does well in school.  He was unaware of his nephew's history of depression until now.  Which of the following is the most appropriate course of action?

Quizplus · Accepted Answer

Explanation: This physician is confronted with the common ethical dilemma of being asked to treat a family member. Physicians may be well intentioned in wanting to help a family member, but must be aware of important ethical issues involving both beneficence (acting in the patient's best interest) and nonmaleficence (doing no harm). Dangers include overriding the patient's right to participate in health care decisions, potential lack of informed consent, potentially treating conditions beyond the physician's training and expertise (eg, adolescent depression), lack of patient confidentiality, lack of appropriate follow-up and documentation, failure to perform an adequate assessment of sensitive issues, and the possibility that the patient will not be forthcoming due to the nature of the family relationship. For example, this physician may feel uncomfortable asking either his sister or his nephew about substance use or suicidality. Furthermore, even if the physician asks his nephew these questions privately, the patient may feel uncomfortable discussing these topics with his uncle (Choice A). (Choices C and D) Although it is not illegal, published ethical guidelines and medical organizations recommend against treating family members, with the exception of emergency situations when no other health care provider is available. (Choice E) The family relationship compromises the physician's ability to adequately assess the patient's suicide risk. Educational objective: Treating family members is generally considered to be ethically problematic. Acute and limited care may be appropriate when no other physician is available. References: No appointment necessary? Ethical challenges in treating friends and family. (http://www.ncbi.nlm.nih.gov/pubmed/25251620)

A Physician Receives a Phone Call from His Sister Requesting