After your rotation, is it appropriate to call up a patient out for drinks?

[bestcoast]

For non-sexual reason?
Today, I met a patient whose parents were neighbors to my grandparents.
They were all diplomats back in the days hence a simple conversation today revealed about this coincidence.

I kinda just want to meet up with him to chat about our ancestries. Patient offered his phone number but I declined. We are both male heterosexual. Is that appropriate to call him up?

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[SpecterGT260]

For non-sexual reason?
Today, I met a patient whose parents were neighbors to my grandparents.
They were all diplomats back in the days hence a simple conversation today revealed about this coincidence.

I kinda just want to meet up with him to chat about our ancestries. Patient offered his phone number but I declined. We are both male heterosexual. Is that appropriate to call him up?

I would say it is technically ok. But I would personally err on the side of caution.

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[kindasorta]

For non-sexual reason?
Today, I met a patient whose parents were neighbors to my grandparents.
They were all diplomats back in the days hence a simple conversation today revealed about this coincidence.

I kinda just want to meet up with him to chat about our ancestries. Patient offered his phone number but I declined. We are both male heterosexual. Is that appropriate to call him up?

 

[Poetic Silence]

It is a conflict of interest and unethical. I do not advise it.

 

[SpecterGT260]

It is a conflict of interest and unethical. I do not advise it.

How is it a conflict of interest?

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[Poetic Silence]

How is it a conflict of interest?

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The ability to make unbiased decisions regarding patient care relies upon professional distance so as to prevent transference.

 

[SpecterGT260]

The ability to make unbiased decisions regarding patient care relies upon professional distance so as to prevent transference.

While true, that isn't really what "conflict of interest" means
So how do you think that applies to this situation?.....

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[kindasorta]

The ability to make unbiased decisions regarding patient care relies upon professional distance so as to prevent transference.

Even if we want to play in make-believe land and pretend that the OP had any decision-making capacity with respect to patient care, he's no longer "his" patient. The OP will never see this man again in a medical capacity. The professional relationship is over (even though it never began, but I digress).

So they can go and meet and enjoy their super-hetero espressos while they take a stroll down memory lane and compare stories of their slave-owning great great grandfathers without consequence.

 

[Poetic Silence]

While true, that isn't really what "conflict of interest" means
So how do you think that applies to this situation?.....

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The OP's job is to provide unbiased medical care to a patient. Pursuing personal relationships with a patient breaches the doctor-patient relationship and presents opportunity for transference that can provoke problems down the road.

That is the very definition of conflict of interest.

 

[SpecterGT260]

The OP's job is to provide unbiased medical care to a patient. Pursuing personal relationships with a patient breaches the doctor-patient relationship and presents opportunity for transference that can provoke problems down the road.

That is the very definition of conflict of interest.

No. That isn't its definition. See the post above yours for the rest of what I would say here.

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[Poetic Silence]

Look, I'm not gonna argue here. I'm simply answering the question. This is introductory ethics **** and I'm a philosophy student.

Have your little "hetero-espressos," I don't care. Do whatever you want, no skin off my back. I'm merely an outside party.

And now I'm gone.

By the way, there's nothing hetero about espresso.

 

[SpecterGT260]

Look, I'm not gonna argue here. I'm simply answer the question. this is introductory ethics **** and I'm a philosophy student.

Have your little "hetero-espressos," I don't care. Do whatever you want, no skin off my back. I'm merely an outside party.

And now I'm gone.

By the way, there's nothing hetero about espresso.

Fortunately they will cover ethics in medical school for you. Until then

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[kindasorta]

Look, I'm not gonna argue here. I'm simply answering the question. This is introductory ethics **** and I'm a philosophy student.

Have your little "hetero-espressos," I don't care. Do whatever you want, no skin off my back. I'm merely an outside party.

And now I'm gone.

By the way, there's nothing hetero about espresso.

 

[Law2Doc]

Fortunately they will cover ethics in medical school for you. Until then

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Speaking as someone who already completed med school, I've gotta agree with the philosophy major here. No it's generally not ethically appropriate to get together socially with someone you met in a doctor patient (or even student doctor patient) setting. Conflict of interest is probably not the right term, but you are walking a very ethically dangerous line here. And no, your role doesn't end when the rotation ends -- much as you are prohibited from dating patients even after they are discharged from the hospital. Once you served in a caregiver role, they are ethically off limits.

The OPs scenario is just very inappropriate. You know things about them from their medical records that normal acquaintances shouldn't know, And they see you in the role of a caregiver and health decision maker that creates a social unbalance. There are psychological phenomena at play that give caregivers an extreme upper hand in subsequent social relationships, and most ethical codes try to limit socialization (during and subsequent to treatment) for this reason.

 

[deleted87716]

The OP's scenario sounds pretty innocuous, IMO, although it's always a bit risky to meet up with people whom you don't know very well.

There is nothing unethical about socializing with patients. If you live anywhere near where you work, particularly if you're in primary care, you're going to meet your patients in every walk of life. You won't always have the "upper hand," either. In some cases, you may have been friends with someone before they became your patient. In all situations, it's important to be conscious of boundaries and to keep your social interactions and professional interactions separate. You also need to be aware of your demeanor, as your behavior in social settings will reflect on you professionally.

Obviously, some of us will be able to handle this better than others. As Dirty Harry said, "A man's got to know his limitations."

 

[SpecterGT260]

Speaking as someone who already completed med school, I've gotta agree with the philosophy major here. No it's generally not ethically appropriate to get together socially with someone you met in a doctor patient (or even student doctor patient) setting. Conflict of interest is probably not the right term, but you are walking a very ethically dangerous line here. And no, your role doesn't end when the rotation ends -- much as you are prohibited from dating patients even after they are discharged from the hospital. Once you served in a caregiver role, they are ethically off limits.

The OPs scenario is just very inappropriate. You know things about them from their medical records that normal acquaintances shouldn't know, And they see you in the role of a caregiver and health decision maker that creates a social unbalance. There are psychological phenomena at play that give caregivers an extreme upper hand in subsequent social relationships, and most ethical codes try to limit socialization (during and subsequent to treatment) for this reason.

Did you read my first post on the subject? You say you agree with the pre med but the content of your post echoes mine almost exactly.

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[cabinbuilder]

The OP's scenario sounds pretty innocuous, IMO, although it's always a bit risky to meet up with people whom you don't know very well.

There is nothing unethical about socializing with patients. If you live anywhere near where you work, particularly if you're in primary care, you're going to meet your patients in every walk of life. You won't always have the "upper hand," either. In some cases, you may have been friends with someone before they became your patient. In all situations, it's important to be conscious of boundaries and to keep your social interactions and professional interactions separate. You also need to be aware of your demeanor, as your behavior in social settings will reflect on you professionally.

Obviously, some of us will be able to handle this better than others. As Dirty Harry said, "A man's got to know his limitations."

I agree with blue dog. This is especially true in rural medicine. I see my patients every day at the movies, at the store, at the gas station, they are my staff members, the other doctor's family members. We all socialize after hours otherwise I would be trapped and lonely at home having no life.

I don't see any problem with socializing since your rotation is over. The reason for the get together is very benign. You just have to be careful if the conversation turns into a medical advice seeking event and in that case you will need to redirect and decline to answer. Patients are always tryingto find a way to get prescriptions and advice without having to pay for it.

 

[samsoniter]

agree with blue dog and cabinbuilder (as usual).
IMO life is too short to get caught up in some of the ethical hooey and as long as you respect boundaries and keep the conversation social (as opposed to medical) I see nothing wrong with a casual get together with a former patient. TRUST ME, physicians and patients engage in friendships (and though unethical-sometimes more) all of the time. It is a mostly unavoidable consequence of practice- particularly in a less than metropolitan environment. I say go for it, again life is too short and I really don't see much potential detriment in such an activity.

 

[Poetic Silence]

Wait, what?

 

[samsoniter]

I know poetic silence! I realize this may be a shocker, or seem downright incorrect to you, which I completely understand. But bear in mind you are currently viewing things through the idealistic lens of the theoretical, as one would expect in a premed philosophy course....I am viewing them from the (perhaps) jaded perspective of someone who has endured the rigors of a top 10 medical school curriculum....
Lastly, in a not so subtle attempt to dodge any philosophically weighted flak, would consanguinity be morally acceptable if there was no intent to procreate? I think a savvy philosopher could make a very sound argument for yes.

 

[SpecterGT260]

It's good to know that I will still have time to get bored as a resident

 

[michaelrack]

Don't have sex with him or do a business deal with him. If you avoid those 2 areas, I think you are ok.

 

[dpmd]

Don't have sex with him or do a business deal with him. If you avoid those 2 areas, I think you are ok.

This.

The fact that you have a duty to a patient that extends beyond the time they are physically undergoing care with you in no way means that you can't engage in appropriate social activity. Appropriate being the key word. Sex and business relations are out because of the imbalance inherent in your relationship. Speaking together in a social setting (where you each purchase your own beverages, and I would argue that alcohol is not strictly wrong but does have more potential for inappropriate interaction) that you purposefully set up versus one that happens as a coincidence (you happen to be at the same establishment and strike up a conversation) is not going to get anyone in trouble, rightfully so I would say.

The weird thing to me would be meeting someone in any circumstance and having them want to get together for drinks to talk about our grandparents. But that is just me.

 

[NotAProgDirector]

I agree with CabinBuilder and BlueDog. There is nothing inherently unethical about having a friendship with a patient. Thoughts:

1. It's fine as long as you're 100% certain that the patient is comfortable with the situation. If, in the OP's case, the OP had asked the patient "Hey, I'd love to meet to talk more about my grandfather", it's a bit more complicated as the patient might feel obligated to do so for the physician. But when initiated by the patient, it's totally fine.

2. Agree that in smaller areas, this happens all the time.

3. Agree that you need to separate the medical stuff from the personal stuff. However, I can tell you that doing so is virtually impossible. If you end up being friendly with a patient, it's certain to lead to a situation where your friend/patient asks for medical advice in a non-medical setting. "Can you take a quick look at this rash?", for example. Note that your non-patient friends are likely to do this also, it's easy to tell them that you are not their doctor. You'll need to decide how to handle this situation. The "easy" answer of "You need to come see me in the office" doesn't really work.

4. Romance is a bright line never to cross. A question sometimes asked (and honestly what I thought this thread was going to be about) is: "I saw this patient that I think is cute/handsome, and I want to ask them out on a date, is that OK?". Opinions differ. My thought is that it is fine to ask a former patient out on a date -- but the second you ask, they are never again your patient (regardless of their answer) In fact, if you find yourself truly attracted to a patient, it's best to transfer them to someone else's care, even if you don't pursue it.

5. I actually don't see any problem with a "business deal", as long as it's not a medical thing. Is it really wrong for a physician to care for the dentist who cleans their teeth? As long as both are paying market prices for services, I think it's fine. It can become a problem if one of your patients offers you a "good deal", you take it, and then later they claim that you "owe" them something. The key is "no special deals". If you go to your patient's restaurant for dinner, you pay for your meal.

6. As the physician, you need to monitor your own well being / situation. Being friends with your patients is a great experience -- in fact, if you're not friends with your patients on some level, I think you've missed one of the great joys of primary care. But, if you become overly emotionally involved with a patient, it can impair your judgement and/or create conflicts. Let's say you're caring for a friend and his/her spouse, and the spouse admits to you that they are having an affair. You need to be ready to deal with that. You could continue caring for the two of them, you could ask the spouse to switch to a new doc, you could ask both of them to switch to new docs -- but in no case can you tell your friend. If you can't handle this, then you need to avoid the situation.

The bottom line is that all of these situations involve some risk of developing into an inappropriate situation. The risk is small in most cases, and can be managed by the physician. One could decide to avoid situations like this completely, which solves any "conflict" issues but is quite restrictive.

Specifically for the OP, I see almost no downside issues here.

The OP treated the patient once, and will have no ongoing care for the patient.
The OP didn't "pick" to treat the patient as a way to get "in" to a friendship.
The issues the OP wants to talk to the patient about are independent from the medical issue.
The request was initiated by the patient.

I see no conflicts here at all. Is there a chance that when the OP goes to meet the patient, that they will say "actually, I really wanted to talk to you about that medical problem away from everyone else..."? Sure, but if he does, then the OP simply ends the conversation, offers to see the patient again in clinic, etc.

 

[Law2Doc]

...

4. Romance is a bright line never to cross. A question sometimes asked (and honestly what I thought this thread was going to be about) is: "I saw this patient that I think is cute/handsome, and I want to ask them out on a date, is that OK?". Opinions differ. My thought is that it is fine to ask a former patient out on a date -- but the second you ask, they are never again your patient (regardless of their answer) In fact, if you find yourself truly attracted to a patient, it's best to transfer them to someone else's care, even if you don't pursue it...

.

Just FYI, the AMA code of ethics provides that at a Minimum you must end your role as physician before asking out a patient, but says that in many cases a relationship will still be unethical, as the balance of power and position will always be there. This was one of the original prohibitions in the Hippocratic oath, and as a physician is seen in a paternalistic role, some commentators suggest this should be ethically regarded like incest.
So I think you might be out on a Bit of a limb by yourself saying it's globally "fine", though some would find it less ethically troubling than others depending one the facts and circumstances of each case. Not surprisingly, the doctors least likely to abuse their position in an emotional relationship are also probably those least likely to ask out a patient in the first place.

I'm sure things can differ in a rural setting where the whole town is your patient, and you can't maintain a professional distance, but I don't know if that's the situation we are discussing.

Also lots of worms in the can in the above situation. Your doctor asks you out for drinks. Is he condoning drinking? How many drinks? And will the patient be trusting the doctor in terms of what's healthy? Was this really a platonic exchange of numbers? Does the patient think this too? What if the patient lights up a cigarette -- are you going to stop him? Or eats a greasy cheeseburger, and you just treated him for, say, CAD? If you don't, is his doctor condoning these actions? Even if its nonsexual, going out for drinks with someone you met as your patient creates a lot of messy situations.

 

[gutonc]

Don't have sex with him or do a business deal with him. If you avoid those 2 areas, I think you are ok.

A thousand times this.

Very simple calculus here. Are you going to call this person up to go have a beer or for a booty call? If it's just a beer, is that an attempted prelude to a booty call on your part (or his/hers)?

If the answer in any way involves the word "booty" then don't do it. Otherwise...whatever.

 

[dpmd]

To clarify, I meant trying to get the patient to invest in something or starting a new business together when I was saying don't get involved in business together. I went to a hair salon and discovered my stylist was a patient I had treated years ago as a resident. I never had any question of it being proper and will have no qualms going back to see her.

 

[Law2Doc]

A thousand times this.

Very simple calculus here. Are you going to call this person up to go have a beer or for a booty call? If it's just a beer, is that an attempted prelude to a booty call on your part (or his/hers)?

If the answer in any way involves the word "booty" then don't do it. Otherwise...whatever.

Sometimes the beer itself is what makes it easier to go down the wrong path though. If people thought clearly on beer, a lot would be different in life.

 

[gutonc]

Sometimes the beer itself is what makes it easier to go down the wrong path though. If people thought clearly on beer, a lot would be different in life.

I've made more than my fair share of alcohol-fueled bad decisions in life. But the seed of them was always at least somewhat based in sober reality. Beer goggles aren't all powerful.

 

[Poetic Silence]

Just FYI, the AMA code of ethics provides that at a Minimum you must end your role as physician before asking out a patient, but says that in many cases a relationship will still be unethical, as the balance of power and position will always be there. This was one of the original prohibitions in the Hippocratic oath, and as a physician is seen in a paternalistic role, some commentators suggest this should be ethically regarded like incest.
So I think you might be out on a Bit of a limb by yourself saying it's globally "fine", though some would find it less ethically troubling than others depending one the facts and circumstances of each case. Not surprisingly, the doctors least likely to abuse their position in an emotional relationship are also probably those least likely to ask out a patient in the first place.

I'm sure things can differ in a rural setting where the whole town is your patient, and you can't maintain a professional distance, but I don't know if that's the situation we are discussing.

Also lots of worms in the can in the above situation. Your doctor asks you out for drinks. Is he condoning drinking? How many drinks? And will the patient be trusting the doctor in terms of what's healthy? Was this really a platonic exchange of numbers? Does the patient think this too? What if the patient lights up a cigarette -- are you going to stop him? Or eats a greasy cheeseburger, and you just treated him for, say, CAD? If you don't, is his doctor condoning these actions? Even if its nonsexual, going out for drinks with someone you met as your patient creates a lot of messy situations.

I stand behind this post. You as a physician have an unfair leverage over the patient even if you never treat him again. That in itself can cause all kinds of headaches.

 

[PlutoBoy]

Just FYI, the AMA code of ethics provides that at a Minimum you must end your role as physician before asking out a patient, but says that in many cases a relationship will still be unethical, as the balance of power and position will always be there. This was one of the original prohibitions in the Hippocratic oath, and as a physician is seen in a paternalistic role, some commentators suggest this should be ethically regarded like incest.

Could this have any repercusions such as getting your license revoked?

 

[michaelrack]

To clarify, I meant trying to get the patient to invest in something or starting a new business together when I was saying don't get involved in business together. .

that's what I meant too.

The prohibitions against business deals (including the above and also loans between the pt/doc) as well as against sex are absolute for psychiatrists. Other docs have more options. Psychiatrists aren't supposed to ever have sex with a former patient.

 

[Poetic Silence]

that's what I meant too.

The prohibitions against business deals (including the above and also loans between the pt/doc) as well as against sex are absolute for psychiatrists. Other docs have more options. Psychiatrists aren't supposed to ever have sex with a former patient.

Who would want to have sex with a psychiatrist other than his patients?

 

[Khaos]

I have one question. How many of you have written a prescription for abx to a family member? Does that mean that you can no longer speak or socialize with them. I have a hard time seeing a breech in socializing with a patient that has no chance of seeing you as a physician again. I also will agree with the idea of no sex, no business adventures. I have written a prescription for antibiotics for my best friend and brother in law, kept good documentation, and left it at that. There is nothing unethical about socializing with them after. How many PCP's in a rural area treat neighbors, friends, and family. I have treated several of the nurses that come in to the emergency department for their complaints and even treated one of the my partners that I socialize with in a regular basis. Should I have refused to see them (difficult since I was the only emergency doc on at the time and thus would be a violation of EMTALA). Does that mean that I can no longer socialize with them? I have no intention of ever having sex with them...the partner and I have talked about doing research and even being involved in a new product that could be commercialized for emergency medicine. Would this be considered a breech in ethics?

I don't think that meeting a family friend by chance in an office and then wanting to learn more about both families would be a breech.

 

[dpmd]

I stand behind this post. You as a physician have an unfair leverage over the patient even if you never treat him again. That in itself can cause all kinds of headaches.

In what manner are you thinking this unfair leverage would play out in a social setting without sex or business deals being involved?

 

[kindasorta]

In what manner are you thinking this unfair leverage would play out in a social setting without sex or business deals being involved?

He's not thinking. He's parroting hackneyed aphorisms.

 

[michaelrack]

x

 

[deleted87716]

Could this have any repercusions such as getting your license revoked?

Having sex with patients can definitely get you disciplined by your state BOM, with penalties up to and including forfeiture of licensure. The BOM has a duty to protect the public.

 

[Law2Doc]

I have one question. How many of you have written a prescription for abx to a family member? Does that mean that you can no longer speak or socialize with them....

No. The issue is people you meet in the healthcare setting. Friends and families you have known previously don't pose quite the same issues.

 

[oldbearprofessor]

Speaking as someone who already completed med school, I've gotta agree with the philosophy major here. No it's generally not ethically appropriate to get together socially with someone you met in a doctor patient (or even student doctor patient) setting. Conflict of interest is probably not the right term, but you are walking a very ethically dangerous line here. And no, your role doesn't end when the rotation ends -- much as you are prohibited from dating patients even after they are discharged from the hospital. Once you served in a caregiver role, they are ethically off limits.

I will have to stop being FB friends with several young adults whom I took care of when they were tiny preterm infants in the 1980's.

1. I saw them "not entirely" clothed in the NICU.
2. I know stuff about them not even their mothers know.
3. Even 20+ years later they tend to call me "Dr. OBP" reflecting that they still think of me as their neonatologist.

Thanks! Will delete now before they have babies of their own and I get into all sorts of complex ethical scenerios.

 

[SpecterGT260]

I will have to stop being FB friends with several young adults whom I took care of when they were tiny preterm infants in the 1980's.

1. I saw them "not entirely" clothed in the NICU.
2. I know stuff about them not even their mothers know.
3. Even 20+ years later they tend to call me "Dr. OBP" reflecting that they still think of me as their neonatologist.

Thanks! Will delete now before they have babies of their own and I get into all sorts of complex ethical scenerios.

I tend to think FB friending across a generation gap is weird to begin with but that's just me

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[oldbearprofessor]

I tend to think FB friending across a generation gap is weird to begin with but that's just me

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Thanks for sharing. Then I should refuse friend requests from anyone more than 15 years younger than me, even if I was their mentor and they wish to use FB to keep in contact and seek advice so as not to be seen as weird? What about my professional colleagues? After all, lots of them are a generation younger than me.

Edit: Is LinkedIn okay? What about Pinterest?

 

[michaelrack]

I tend to think FB friending across a generation gap is weird to begin with but that's just me

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There are different ways of using Facebook. I am FB friends with some people at my company who are almost 20 yrs younger than me, and I have one colleague on FB who is 20 years older than me. Members of my company use FB for informal communications and to keep track of birthdays.


I spend little time on FB, but find that it is an easy way to wish someone "happy birthday"

I use Linkedin for professional "connections", but find that it is pretty useless. I have over 250 connections and get endorsed for skills by connections I have never met. But maybe LinkedIn will be useful if I ever need to hunt for a job, so I will keep on forming connections.

 

[BolderNewfy]

He's not thinking. He's parroting hackneyed aphorisms.

Typical L2D, focused more on winning an argument than actual reality.......

 

[mimelim]

s

 

[SpecterGT260]

Thanks for sharing. Then I should refuse friend requests from anyone more than 15 years younger than me, even if I was their mentor and they wish to use FB to keep in contact and seek advice so as not to be seen as weird? What about my professional colleagues? After all, lots of them are a generation younger than me.

Edit: Is LinkedIn okay? What about Pinterest?

For the record, I am endlessly amused at how personally you took a statement of personal opinion

Try real hard and see if anything you responded with was in any way relevant to my post use whatever you want however you want. Won't change my opinion, and my opinion shouldn't change yours

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[duckie99]

OP in my opinion if you are questioning the move at all then don't do it. Honestly, you are probably ethically ok but it's more of a hassle then you want. If you see patients in the "paternalistic" sense this likely would never have even come up.

Personally, I'm just going to avoid contact with patients outside a medical setting. In situations where that is not possible a friendly "hello" is likely all that would be necessary. BTW I'm not doing rural medicine so it really shouldn't be that big a deal... also my patients are likely to be older adults (50s-60s).

 

[Law2Doc]

...
Personally, I'm just going to avoid contact with patients outside a medical setting. In situations where that is not possible a friendly "hello" is likely all that would be necessary. BTW I'm not doing rural medicine so it really shouldn't be that big a deal... also my patients are likely to be older adults (50s-60s).

I'm not suggesting you have to avoid them, cross the street if you see them walking by, strike them from your Facebook contacts, etc. But I do think there are lines we all must draw and perhaps asking them out for drinks is on the wrong side of the line for a lot of folks, for many if the reasons described above.

 

[NotAProgDirector]

I have one question. How many of you have written a prescription for abx to a family member?

I realize this is off topic, but I don't think this is a good habit to get into. IMHO, You should really only treat your patients, not family members or friends (unless such friends truly are your patients, which is the topic of this thread). Why, you ask? From your post it appears you actually document what you did, for example. Well:

1. Where exactly is this documentation? It's part of a medical record, and there are all sorts of rules about that. Keeping a file on your computer, or a paper record in your house, won't meet the standards involved. I realize this is a really small issue, and unlikely to get anyone in trouble on its own, so perhaps a bit of a straw man.

2. In general, if a friend has a problem that really needs an abx, they should see their provider. If they have a cold, they don't need an abx.

3. Although unlikely, what happens if your friend has a severe reaction to the antibiotic. It's very rare, but certainly happens -- someone anaphylaxes, or develops TEN, or severe C Diff and ends up with a colectomy, etc. All of a sudden, they're out of work, have no income, and all sorts of expenses. Perhaps they decide to sue you for malpractice. Sadly, you're likely to discover that your medmal insurance doesn't cover you. This is also very variable -- it totally depends on your medmal insurance, the carrier, and the circumstances. It will also depend on your record keeping (which interestingly raises issue #1 again).

This thread is talking about the ethical issues involved with having a friend be a patient at the same time. I find it more ethically problematic to provide care for friends who are not enrolled patients.

That said, there are always exceptions. In an emergency, you do what needs to be done. I will refill family/friends chronic prescriptions for things that are non-controlled and harmless -- for 2 weeks with no refills, once. If I saw a friend who developed a zoster rash in the last 24 hours, I'd prescribe an antiviral (since time is of the essence), but still have them see their doc. Etc. But Abx for a URI for a friend who is "going on a trip" is a never event for me.

Which brings us back on topic. The issue with ethical challenges like this is that there is rarely a "right" or "wrong" answer. Some things are always wrong -- sex with patients, for example. Most things are in the grey, can work out fine or can be a disaster. Each of us needs to assess what we're willing to risk, and how to manage that risk, based upon our own circumstances. Like treating family/friends for minor issues -- chances are, nothing bad is going to happen and all will be good. There is a small but real chance of a big problem. We all need to decide whether we're willing to face that risk, how to manage it, how to recognize when we've reached a problem, and how we'll deal with that.

 

[ForbiddenComma]

Agreed with the above... I rarely will refill something relatively innocuous that they're already on such as lisinopril or albuterol and it's a weekend. But not abx, narcs, benzos, or amphetamines.

As far as the relationship question goes, the standardized tests during med school were very black-and-white about this. If you first met the person because they were your pt, you may not have an out-of-work relationship with them, ever, full-stop. I'm not such an absolutist; and I believe that setting strict emotional barriers between yourself and your patients may actually impede health care. On the other hand, boning your patients is unacceptable unless you are a U.S. congressman from Tennessee.