Treating family and friends: how close is too close?

We regularly receive enquires to the Professional Advice Service about treating family, friends or colleagues. What if you are asked by friends or family to provide an opinion or treatment for their condition? What if you are the most appropriate clinician to treat someone close to you with complex needs who ends up in your service? 

What does the HCPC say? 

The Health and Care Professions Council (HCPC) does not stipulate if you can treat family or friends.

However, according to the HCPC standards and the CSP Code of Members’ Professional Values and Behaviour, you must declare issues that might create conflicts of interest and make sure that they do not influence your judgement. The HCPC also states you must keep your relationships with service users and carers professional.

Prescribing 

People you prescribe for should be formally on your caseload. Wherever possible, avoid prescribing for those close to you, unless no other prescriber is available to assess their clinical condition and to delay prescribing would put their life or health at risk or cause intolerable pain; the treatment is immediately necessary to save life, avoid serious deterioration in their health and well-being or alleviate otherwise uncontrollable pain.

Weighing up the decision to treat

There is no black and white answer and there are many things you need to consider before agreeing to treat someone close to you. A conflict of interest doesn’t mean that you cannot treat someone, however we urge caution and careful consideration of the risks, as well as the alternatives available for meeting the person’s needs.

Conflict of interest 

It is important that you are honest and transparent. Declare where there may be a conflict of interest to your manager, if you have one. If you are employed you must check your employer’s policy on whether you are permitted to treat family, friends and colleagues. If you are a private practitioner, you may wish to have your own policy. 

Your decision to treat someone close to you may be impacted by the circumstance, for example, if you were on call and called to a patient in an emergency. You have a duty of care to consider where your actions, or failure to act, might cause injury to another person. In this case, you may choose to treat someone close to you where no one else is available to provide the care in a timely manner to not cause harm. 

Generic advice versus duty of care 

We may want to help those closest to us when they ask, but you need to consider the line between giving generic advice and opening up a duty of care. Be clear about the expectations of the requester and yourself, including whether you are being asked for simple factual information, your medical judgement and opinion, or more substantial clinical assessment and treatment.  

If a family member or friend asks you for advice and you go beyond providing simple factual information, for example you assess them and provide your clinical judgement, you need to apply the same principles you would when treating any patient and adhere to HCPC standards. This would include record keeping and having appropriate indemnity insurance cover. To some this may appear overkill but there have been HCPC cases where an ex-husband has reported their ex-wife upon separation. So don’t get caught out. 

Keep clear documentation so you can demonstrate that you have treated this person with the same professional expertise and judgement as you would any patient. This also applies if you are offering any advice or treatment for free. 

It may be worth questioning yourself, if treatment is not an emergency, and you are not the only clinician in the service or area with the appropriate knowledge and skills to treat someone close to you, would it be more appropriate to remove any conflict of interest by being treated by another physiotherapist? 

Outside of work you may want to consider where you are happy to set your boundaries between personal and professional life.