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Pitfalls of Treating Family Members

Surveys reveal that the overwhelming majority of physicians have, at some point in their careers, received requests from family members for medical advice, diagnosis, or treatment.  Doing so creates a variety of risks to both the physician as well as the patient.  Nevertheless, and quite obviously, denying such requests from family members can prove exceedingly difficult.

In its Code of Medical Ethics, the American Medical Association (AMA) states that “physicians generally should not treat themselves or members of their immediate families.”  Among the reasons advanced by the AMA to support this opinion are that personal feelings may influence medical judgment, patients may feel uncomfortable disclosing sensitive information, and tensions may develop in the professional relationship that will negatively impact the personal relationship.

In addition to such ethical standards, state licensing boards may impose restrictions on such treatment situations through their own regulations or opinions.  Hospital medical staff bylaws and rules, too, may limit the treatment of family members.  Health plans and third-party payors may limit coverage for any care rendered.  Should the physician reduce the overall charge to the family member, or waive any patient-responsible amount (ex. engage in insurance only billing), a variety of health care and insurance fraud and abuse laws may be implicated.

Treating family members also carries the risk of professional liability in the form of lawsuits.  Any time the physician-patient relationship is established, medical malpractice liability may arise.  An informal care setting, such as among related persons, can create ambiguity as to whether the relationship has been established.  There is no recognized exception, however, for familial relationships in Pennsylvania case law involving medical malpractice claims.

In order to mitigate these risks, physicians and group practices may decide to avoid any treatment of family members.  For those that decide to continue to advise, diagnose, or treat family members, it is advisable to review the applicable ethical standards and rules; and then establish and strictly follow a written policy to ensure compliance.  It is important that any such treatment provided in the usual patient care settings, such as a physician’s office, and to document all such treatment in the same manner as with any other patient.  Before applying any discount to charges for care rendered to family members, be sure to review and follow all applicable public and private third-party payor rules.

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