Advice to the Profession: Treatment of Self, Family Members, and Others Close to You

Physicians may find themselves in circumstances where they must decide whether it would be appropriate to provide treatment for themselves, family members, or others close to them.

While physicians may have a genuine desire to deliver the best possible treatment, research suggests that a physician’s ability to maintain emotional and clinical objectivity may be compromised when treating themselves or others close to them. This can impact the physician’s ability to meet the standard of care and compromise the quality of treatment provided to the individual.1

This document is intended to help physicians interpret the expectations set out in the Treatment of Self, Family Members, and Others Close to You policy and provide guidance about how these expectations can be met.

Objectivity and Factors Affecting Professional Judgment

A relationship can reasonably affect a physician’s professional judgement in a number of ways. For example, a physician may:

• feel uncomfortable discussing sensitive issues such as sexual history, mental health, substance use, abuse or neglect.
• feel obligated or pressured to treat problems that are beyond their expertise or training, or to prescribe drugs that are addicting/habituating, including narcotics or controlled substances.
• have difficulty recognizing the need to obtain informed consent and to respect the individual’s decision-making autonomy.
• have difficulty recognizing that the duty of confidentiality applies the same way it would for a patient.
  • For example, the physician may experience pressure to disclose confidential information if others close to the physician insist on knowing ‘what is going on’ in relation to an individual’s health.
• be reluctant to make a mandatory report.
  • For example, an impairment affecting the individual’s ability to drive, or a suspicion of child abuse.

Physicians need to consider if the relationship may affect the individual’s openness to disclose important information, raise concerns about proposed treatment, or take appropriate next steps after treatment. This includes the individual:

• being uncomfortable discussing sensitive issues like substance use, sexual history, mental health, abuse, or neglect;
• feeling obligated to accept a physician’s treatment recommendations; and
• being reluctant to make a complaint, or pursue legal options.

Pressure to Provide Treatment

Physicians may feel pressured by family members or others close to them to provide treatment even when they don’t feel it would be appropriate. Physicians can explain to the person seeking treatment that this policy sets out professional expectations that they must uphold, which includes not providing treatment beyond the exceptions set out in the policy.

Treating Sexual and Romantic Partners

Ontario legislation defines who is a patient for the purpose of determining whether sexual abuse has occurred2. If a physician provides treatment to a patient where there was or is a sexual or romantic relationship, a physician can be found to have committed sexual abuse.

For more information about providing treatment to sexual and romantic partners, please see the Legal Requirements: Treatment of Sexual and/or Romantic Partners document.

Minor Conditions

Depending on patient-specific factors, a few examples of minor conditions may include:

• Minor skin conditions;
• Minor uncomplicated infections; and
• Minor injuries.

Patient-specific factors include but are not limited to:

• Age;
• Past medical history; and
• The severity of the symptoms.

Physicians are advised to use their professional judgment to determine whether a person has a minor condition, and whether treating the minor condition would be appropriate given their scope of practice.

Alternative Treatment Options

Examples of when a person would have other treatment options include having:

• The ability to travel to another community within a reasonable distance where they could obtain care even if less convenient;
• Access to virtual care options that meet their treatment needs; or
• The ability to be treated by another qualified health-care professional provider despite personal preferences (e.g., religious, language, ethnicity, or gender preferences).

In contrast, a person may not have other treatment options if:

• They are not reasonably able to travel to another qualified health-care professional and cannot access virtual treatment options (e.g., people experiencing homelessness);
• The only available physicians are those with whom the person has had a significant breakdown in the physician-patient relationship; or
• There are severe systemic or other issues affecting the person’s trust in the health-care system that may reasonably prevent the person from seeking care elsewhere (e.g., Indigenous people or individuals with a history of sexual abuse).

Indigenous Communities

CPSO recognizes that physicians practising in Indigenous communities may be interconnected with or related to the entire community. Additionally, systemic inequality has deeply affected the trust many Indigenous people have in the health-care system. For Indigenous patients, this may mean they do not have an alternative treatment option that they perceive as culturally safe.

This policy supports physicians practising in Indigenous communities to provide care beyond emergency treatment and treatment for minor conditions in accordance with the policy.