In theory, the doctor-patient relationship is courteous and clinical, rooted in a duty of care. In practice, the line between professional and personal isn’t always clear-cut. Sometimes doctors and patients meet in the exam room and strike up long-lasting friendships. Other times, doctors take on friends as patients.
Some doctors say getting personal enhances care, since providers who know their patients as people are more likely to take a well-rounded, holistic view of their health. Other providers argue that even a tiny boundary breach clouds professional judgment and objectivity. Doctors diagnosing friends can lead to undertreatment based on wishful thinking. Overtreatment happens too. Some doctors call it “VIP syndrome”: When patients are friends, they order unnecessary tests that can bypass the system and its protective measures.
In a 2019 survey of more than 1,500 primary care doctors across the country, 59 percent said they’d provided care to personal friends, while 34 percent had paid for medication and given patients rides home. Only a minority of respondents found these scenarios unacceptable.
“Going the extra mile for patients is often viewed as acceptable,” says Dr. Gordon Schiff, coauthor of the survey and associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital in Boston.
“With this survey and its conflicting answers, we seem to have hit a raw nerve. The answers may reflect that our society is changing. Our relationships may be growing more transactional, our economic and social gaps may be widening, and our community ties may be fraying. But we should always keep the patient at the center of our decisions.”
Here are some guidelines to help patients navigate doctor-patient friendships:
Treat appointments as appointments, leisure as leisure
Make a point only to talk about yourself when the outcome of your conversation bears a billing code. “Because appointments are often limited in time, doctors and patients have to understand they need to focus on the patient’s health,” says Dr. Brian Wind, chief clinical officer at JourneyPure in Nashville, Tennessee. “It can be distracting if a patient and doctor chat about matters that take their focus away from clinical care.”
By the same token, refrain from requesting tests, prescriptions or evaluations at social events or over social media. “Sometimes being friends with patients can mean it’s harder for doctors to ‘switch off,’” Wind points out. “Agree that it is not the doctor’s responsibility to read the social media posts of a patient or respond to them.”
Dr. Neil Seligman, an ob-gyn and maternal-fetal medicine specialist in Rochester, New York, agrees. “Every conversation can’t be free medical advice. There are times when I just want my friends to let me put aside my work for a period of time and to help me compartmentalize.”
Help the doctor remain objective
Avoid the temptation to request testing, antibiotics or anything that requires a careful diagnosis during chance or informal encounters. “Many of my friends chose me as their doctor,” says Dr. Kim Langdon of the digital health clinic Medzino, and their friendship continued. “The only concern I had was losing objectivity and potentially worrying excessively that I might miss something, or else engage in over-testing or over-treating.”
By the same token, personal connections can thrive in good times — and turn sour in bad. “I always worry about what happens after unpreventable complications or other adverse outcomes,” says Seligman. “What would happen if I was delivering a friend’s baby and there was a birth injury?” Though both friendship and therapeutic care can feel cozy and comforting, they are very different bonds.
Your doctor may also decline your friend requests on social media or avoid approaching you in public, to respect your privacy and even your dignity. “Maintaining an unbiased, unemotional attachment aids both patient and doctor in providing the best medical care,” says Dr. Sal Raichbach, director of clinical services at Ambrosia Treatment Center in West Palm Beach, Florida. “People know what I do, so I naturally am the first in the line for general questions at gatherings; but to properly serve a patient fully, I’d need to have a level of access and honesty with them that a friend might not provide me with.”
Don’t use a doctor’s online presence as a patient portal
“When the shift at the hospital or clinic is over, we are free to take off our ‘doctor’ hat,” says Dr. Chanh Ho, head of medical review at Constant Delights. But think twice before you “tag” your doctor on Facebook or DM them with a clinical question.
The American Medical Association encourages doctors to consider separating personal and professional content online to maintain appropriate boundaries. Its Code of Medical Ethics reminds physicians to be cognizant of both patient privacy and confidentiality, and to routinely monitor their internet presence to protect their reputations and avoid undermining “public trust in the medical profession.” Interacting with patients online requires the same “appropriate boundaries of the patient-physician relationship.”
“On social media and elsewhere, the expectation of patient privacy is held sacrosanct,” says Raichbach. “Redirecting patient outreach over social media by replying with a boilerplate message that suggests calling the office or reaching out to the scheduling email” is a best practice.
Embrace your humanity, and let doctors do the same
Dr. Makiko Ban-Hoefen, an oncologist in Rochester, New York, says that the wrenching nature of cancer care can overwhelm friendships — not for lack of emotion, but for too much of it. “Being someone’s oncologist is such an emotionally charged journey, and I’m not sure I could treat a friend,” she says. “And I hesitate to be friends with former patients because I’m often a constant reminder of their chemo and the struggle.” One colleague, she says, hides behind freezer doors at the supermarket when he sees former patients, to avoid triggering their bad memories.
Others in more routine, preventive specialties may cultivate friendships for the same reason: to enhance care.
“Over 28 years of practice, I have had friends become patients and patients become friends,” says Dr. Joseph Salim, owner of Sutton Place Dental Associates in New York City. “I spend a few minutes before and after each appointment talking to my patients about anything on their minds. We need to remind ourselves as practitioners that we are treating the whole of a person: not just their mouths, hearts or skins, but also their concerns, fears and expectations.”
Sometimes friendship with a physician stems from the completion of treatment, or a related life milestone. “I became very close friends with a patient that I delivered at 25 weeks,” says Seligman. “I’ve watched their son grow up for the last four to five years and it’s been so rewarding. We’ve since been to group events together and I’ve been to her son’s birthday parties.”
But whatever your doctor’s stance, a warm and caring bedside manner is always appropriate. The pandemic has imposed distance on every relationship, including doctor-patient ones. Providers are barely recognizable in face shields, masks and PPE. Displays of warmth and humanity may be more important than ever in patient care.
“We may need to go out of our way to overcome those eroding ties,” says Schiff. “Having relationships builds trust, confidence and continuity. Remember, our study found that 59 percent of doctors had cared for a personal friend. It’s not black or white, because there are tricky ethical dilemmas. It has to be done mindfully.”
Like a lot of patients and providers, I’ve toed the line. I occasionally see doctors who are acquaintances — people I’ve chatted with at parties or school pick-up. Unlike strangers, they already know a few things about me, which can help expedite routine Q&A sessions and inject warmth into sterile visits. Dishing about mutual friends, I’ve found, makes it easier for me to confide in them about more serious matters. But these guidelines have made me realize that certain things you do while catching up with a friend — asking them questions and showing an interest in their life — aren’t expected (or helpful) during a medical exam. When I’m in patient mode, the conversation needs to stay focused on my health, no matter who’s wearing the white coat.