Written by: Lynne E. Porter M.D., FACP

Joe and George were good friends, golfing buddies. Joe was a 35-yr-old insurance agent with one small child and a pregnant wife. George, of similar age, saw patients with liver disease at the medical school.

When Joe revealed that he had had mildly abnormal liver tests for some time, George suggested that he see one of his trusted colleagues. However, Joe asked George to take care of him. Against his better judgment, George agreed. Never comfortable caring for family and friends, George understood the difficulty with remaining completely objective. .  .perhaps too little or too much would be done?! He also believed in the medical “superstition” that caring for family or friends increased the likelihood of problems developing. . . .

Because Joe’s tests suggested significant liver disease, George recommended a liver biopsy.  When Joe came in for the procedure, George told him that a fellow would do it, assuring Joe this fellow was excellent. Although the procedure went flawlessly, Joe passed out, apparently lost his pulse, and they called a Code.

The Code team arrived. George and the fellow, both ashen, stood in the doorway. Truth quickly became apparent: Joe had not arrested but simply passed out due to anxiety over the biopsy– fine but shaken. George reassured Joe and walked out, slowly heading to the nurses’ station, muttering “NEVER, NEVER, NEVER again!” and vowing to forevermore follow his gut regarding whether or not to care for a friend or family member.

How do we as docs resolve this very personal moral dilemma—who to treat/not treat and how to determine the best course of action that protects our patients and ourselves? What if I don’t feel right about it, but I’m the best available person for the job? Should I even consider my ability to live with worst case scenario results?

How can those of us with years of practice best advise newcomers to the profession?