- Physicians Treating Family Members: Problematic or a Perk?
- A Cost-Effective Plan for Managing Violence in the Healthcare Setting
- National Risk Control (NRC) On Demand Webinars
Being raised in a family of physicians and nurses was certainly convenient and came with definite perks such as avoiding the emergency department, cost savings and “long-distance diagnosing with benefits.” Who better to treat their own family but those closest to us? Their clinical expertise combined with an attitude of personal investment should be just the right medicine. Well, not exactly.
I know from experience that the practice of providing clinical healthcare to family and friends can be risky. As a young mom, having my dad and brothers readily available for medical advice with my children was advantageous. But on one occasion, poor judgment led my fourteen year-old son to the intensive care unit. In hindsight, it would have been prudent for me to involve only my son’s doctor and not his physician grandpa. Classic case of family medical perks going awry.
What do the “experts” say?
The American Medical Association (AMA)1 states that in general, physicians should not treat themselves or members of their own families. However, it may be acceptable to do so in limited circumstances:
(a) In emergency or isolated settings where there is no other qualified physician available. In such situations, physicians should not hesitate to treat themselves or family members until another physician becomes available.
(b) For short-term, minor health conditions.1
Things to consider when healthcare physicians comes to treating family or friends:
- These individuals often expect you to treat them medically. Set the necessary boundaries and be prepared to communicate your policy.
- Practice within the standard of care and follow your treatment protocols to the letter.
- Decide if you will treat employees on a limited basis or not at all.
- Consider being a “doctor” only to your “patients.” Avoid curbside consults as you need a complete medical history and examination.
- Use caution with situations beyond your scope of training.
- Prescribing medications with a high risk of abuse or for a mental health condition can pose added risks (legal and personal) to those close to you.
- Treating others in casual settings leads to casual follow-up care. Be diligent.
- Keep detailed medical records and manage these patients just as you would with established non-family patients.
Here are some questions that may help you discern if a physician-patient relationship with these persons is in their best interest and yours:
- Do I remember that my personal emotions can interfere with professional objectivity and medical judgment?
- How will you feel if an adverse event occurs? Will you feel at fault? Will you accept that the personal relationship is likely to be jeopardized?
- Due to the close relationship, will this person be at ease questioning your plan of care or medical recommendations?
- Will treating this person be challenging due to questions I may have to ask to make a diagnosis?
- Would confidentiality be a challenge with this person as a patient? What about mandatory reporting if the relative is a minor?
- Will reimbursement be affected?
- Do I realize that there is always the possibility of litigation?
Some healthcare physicians I have consulted choose to avoid treating family members except in emergent or isolated settings. Others are comfortable with ‘weekend’ prescribing and then diligently transferring the patient back to their own physician. Still others have a strict policy that they will not assume care for family.
There are different schools of thought on this dilemma, so I suggest weighing the pros and cons along with invoking common sense and your own discretion.
For more information, contact a member of your Gallagher team or Mary Stoll at 630.694.5377.
Unfortunately, scenes of violence marked by individuals acting out in a dramatic fashion have become a fixture of the daily news cycle, too often taking place in a hospital, medical office building or other care centers. Clinicians and healthcare executives carry the responsibility of initiating actions to minimize and mitigate the risk of these events at their facilities.
These events invariably cause leadership of organizations to review current security measures in place and explore what adjustments can be made while being economically responsible. All too often, initial reaction might be to contract with a security firm or hire a consultant to first conduct an assessment and then provide an action plan with targeted recommendations.
Below are some strategies and tools for managing security risks with minimal cost by promoting the utilization of readily available resources which in many cases are available at no cost.
These programs have the potential to dramatically improve your organization’s risk awareness, underlying factors of volatile incidents and provide practical solutions to dramatically improve your organization’s security management program.
Developing patient communication
It comes as no surprise that many incidents of violence in the healthcare setting come from a disgruntled patient or family member lashing out following a deeply traumatic event. Many of these individuals involved had no previous history of violence or threatening behavior. There are an endless number of reasons an individual chooses to take radical and violent action against a healthcare employee, but the majority stem from incidents involving an agitated patient or family member. In many cases, actions follow an initial frustration of being ignored, disrespected or marginalized by a staff member.
Tools are often available within organizations to assist staff with these moments. Many organizations have active ongoing educational programs on “Disclosure” (Communicating an adverse outcome to patients and family members, “Managing the agitated patient,” “Communication repair with the patient” and numerous other educational programs focused on providing the clinician with communication skills to manage an agitated disgruntled patient. These programs are not promoted as “security” training, but effectively deliver the elements of a comprehensive training program for identifying escalating situations and implementing communication tools to de-escalate these situations. Leaders should carefully consider these programs for all staff, not solely clinicians, especially as frustrations over changes and complications in the healthcare system continue to mount.
Quality healthcare resources at no cost
Appointing responsibility to an individual or committee is a practical place to start. As a first step, reference the OSHA document, “Guidelines for Preventing workplace violence for healthcare workers”. These guidelines provide excellent information for structuring a security management program for healthcare workers.
The next potentially expensive element is staff training. Again, hiring a consultant or security firm may provide a desired result but require significant costs. A less expensive alternative that in no way compromises quality is NIOSH’s training program for healthcare workers. This is an excellent free resource consisting of 13 video units each running 15 minutes (CEs are available).
As your program develops and you begin to focus on specific risks, you’ll eventually address “the active shooter.” Active shooter procedures are often referred to as “Code Silver” in acute care organizations. An excellent tool for assessing your organization and developing a process to respond and train staff is available by the State of California at no cost. Your designated individual or committee will be able to easily extract the program components pertinent to your care setting and tailor the plan to your facility.
- Active Shooter Planning and Response
- Incorporating Active Shooter Incident Planning into Healthcare Facility Emergency Operations Plans 2014
Exploring the safety resource recommendations listed above should provide ample material for establishing a comprehensive program. There is no cost to the organization other than the time staff dedicates to the project. We look forward to providing you with more details on specific safety components as your programs develop.
For more information, please reach out to a member of your Gallagher team or the National Risk Control team at 833.213.8557.
On Demand Webinar: Slip/Trip/Fall Prevention
Slips, trips and falls are a major source of injury throughout this industry for employees and residents alike. Please join us on June 16 as we review the common causes for this major loss category and discuss best practices for controls.
On Demand Webinar: Workplace Violence Preventative Measures for Healthcare
During this webinar, we will discuss how to assess current facility operations as they relate to workplace violence prevention. Explore the different preventative tools that can be implemented to assist healthcare and social services workers who face significant risk of job-related violence on a daily basis.
On Demand Webinar: Home Healthcare Fleet Risk
When was the last time your healthcare organization looked into its fleet safety program? Chances are, it may be your organization’s largest exposure, and a successful fleet safety program will pay real dividends to your bottom line. Join leaders from Gallagher to learn more about the various areas of risk for healthcare fleet safety and for guidance on how to manage your organization’s risk.