The first thing to note is that disgruntled ex-wives, husbands and partners (and friends) have been known to lodge a complaint about their treatment after the break-up of the relationship. This is despite the fact that initially they had requested and/or consented to such treatment from their partner or friend.

In general, the ethical standards for practitioners (including doctors and nurses) strongly discourage, but do not prohibit, them from providing treatment for immediate family members. Potentially acceptable situations are limited to those of necessity (for example, first aid, emergencies, short-term ‘minor’ problems, or where no other practitioner is available at the time – for example, sole practitioners in the outback). However, ethical bodies usually caution practitioners that the patient should be transferred to the care of another independent practitioner as soon as it is practical.

Several potential problems have been identified where practitioners treat their own family members or close friends.

1. The informal nature of the situation often results in a lower standard of care being provided – case taking, treatment and follow-up.
2. Because of the informal nature of interactions (over breakfast, at a party, on the phone in the midst of other conversation, etc), the practitioner may fail to record all encounters, so there may be little or no documentation to consult, compromising the standard of care (and providing no evidence in case of a complaint or litigation).
3. Because of the practitioner’s close association with the person, case taking can either be omitted or can be incomplete or assumed. The practitioner may omit to ask necessary questions (either because they think they already know the person well or because the questions are sensitive) or the patient may feel uncomfortable about disclosing information to their partner or relative. Dishonest answers can lead to inappropriate treatment.
4. Homeopaths often state that the hardest cases to treat are those of family members – they feel the pressure to perform and ‘get it right’; emotional involvement with the person means that they are not as objective as they are with other patients. They tend to ‘fill in the gaps’ with their knowledge of the person from knowing them too well. The patient tends to want to reassure the practitioner that they are ‘better’ when they are not but can deny that they were better if the relationship breaks down.
5. The practitioner may tend to ignore standard guidelines, such as respecting the person’s right to decide about treatment and not to push their own point of view.
6. As a result of the personal relationship, the person may feel obliged to follow the advice of the practitioner, and feel that they are under some duress. The family member may prefer to see another practitioner (either initially or after one or more treatments) but may not be willing to say so, for fear of hurting the person’s feelings or for fear of how this might affect their subsequent relationship (some practitioners might feel anger at the rejection). The family member could feel very awkward and embarrassed about rejecting the practitioner’s treatment and deciding to go to someone else for other opinions, where they would feel free to do so with a non-family-member practitioner.
7. In the desire to help, the practitioner may tend to go beyond their area of expertise.
8. It is extremely difficult to maintain patient confidentiality – information and personal matters obtained during a consultation versus information obtained as part of the family relationship outside of the consultation. The partner/family member/friend has the same right to confidentiality as other patients and would feel justifiably upset if information provided during a treatment session was disclosed to others. But it is difficult for the practitioner to remember which information was provided under which circumstances.
9. Treating family members can result in strained family relations. For example, information gained during a consultation can be used as ammunition in the heat of arguments or the practitioner may be in the awkward position of knowing something about the family member, which they must pretend to other family members that they don’t know.

The general opinion is that there is a danger that the spouse, partner or relative is not treated in the same, objective and professional manner as other patients. The practitioner’s personal feelings may unduly influence their professional judgement and therefore interfere with the care being delivered.

In summary, the general consensus of medical and nursing ethical bodies is that in the treatment of such people in any situation other than first aid and emergencies the practitioner’s closeness to the person can obscure their ability to be objective and therefore impair their ability to provide the highest level of care. Practitioners are prone to omissions, short-cuts and informalities, which can compromise care and can harm the patient. If the relationship breaks down, all this can be used to prove lack of duty of care or negligence.

Therefore, for the benefit of the patient and the practitioner, it would be wise for a practitioner to refer the person to another practitioner for constitutional treatment and on-going care.

If you do need to treat family and/or friends, make sure you keep a thorough clinical record for them in the same way that you do for your other clients.