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This article is intended for physician/family caregivers and physicians treating patients who have physician/family caregivers.
The goal of this activity is to describe ethical issues involved in treating, assisting, and advocating for patients who have physician/family caregivers, according to an American College of Physicians (ACP) ethics case study.
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CME / ABIM MOC Released: 2/21/2020; Reviewed and Renewed: 2/6/2023
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Dr Walsh's mother has been experiencing a loss of appetite and increasing weakness over the past few months. Although Dr Walsh had gently encouraged her mother to call her primary care physician, it wasn't until Mrs Walsh's friends remarked on her weight loss that she finally scheduled an appointment. Initial workup revealed elevated liver function tests and a 4.5-cm abdominal mass.
Dr Walsh, a rheumatologist, wants her mother to be evaluated and treated at the university health system where she practices. Mrs Walsh, her husband, and her 2 other children are reassured by the thought that Dr Walsh will be able to keep a close eye on Mrs Walsh's care. With her mother's permission, Dr Walsh contacted her friend and colleague, Dr Golden, a medical oncologist, who agreed to coordinate a workup for Mrs Walsh with the multidisciplinary team.
Although Dr Walsh is relieved that her mom will be receiving medical care at her health system, she questions the specifics of her own role in facilitating her mother's care. The American College of Physicians (ACP) Ethics Manual, seventh edition,[1] clearly stresses the need for caution in providing direct care to family and friends, noting that the role of advisor is permitted. But how should this be implemented? As a medical professional who is very familiar with her mother's medical history, Dr Walsh can quickly recognize subtle changes in her condition. She wants to use her knowledge and experience to benefit her mother but not to interfere with the medical team. How will she negotiate the boundaries between being her mother's family caregiver and advocate vs assuming the responsibilities of a treating physician? Dr Walsh decides to address her questions and concerns to Dr Golden, the physician who will be coordinating her mother's care.