We have detected you are using Internet Explorer. To provide the best and most secure experience, please use a modern browser as we do not support Internet Explorer.

The dilemma of treating the ones we love

As a health professional, we’re always going to be faced with the professional and personal dilemma of where and when to draw the line when it comes to advice or treatment of loved ones.

If you need help, please call

  • Lifeline- 13 11 14
  • BeyondBlue - 1300 22 4636
  • Suicide Call Back Service - 1300 659 467
Suicide Call Back Service Online Chat

When one of my sons was young, if I ever tried to have a serious talk with him about something he would say “Mum, don’t use your counselling voice on me!”. I never knew whether to be pleased or offended!

My son was quite young at that time but not too young to recognise the change in me as I approached a difficult discussion. What he recognised as my “counselling voice,” was probably a tone that suggested I was trying to remain empathic but still keep some emotional distance. It’s possible, knowing me as an emotional person, that this stranger trying to have a rational discussion with him about something difficult was not really his mother!

When does parenting become “treatment”?

My son’s observation has come back to me recently as I ponder the issue of where we need to draw the line in our decisions about treating our own family members. In the realm of prescribing and referring for physical illness, this boundary is straightforward, but in mental health the boundary can get much more blurred. Much of what we do as thoughtful parents has an element of therapy in it.

How do we know when to get someone else to help? How do we know when our children need help that we cannot provide? What if we feel we are qualified enough and are the best person for the job but in reality we’re not? What can we do if we are well qualified to give them the psychological support they need and do not know anyone who is professionally more qualified than we are? And, importantly, what if they see somebody else for help and we disagree with the therapy being provided?  

The Medical Council of NSW recommends that wherever possible, medical practitioners should not treat themselves or members of their own families for reasons that include, maintaining professional objectivity and difficulty exploring sensitive areas. In its Guidelines, the APS affirms that “combining family or personal relationships with a professional relationship is ethically problematic because the objectivity of the psychologist is compromised, and the psychologist’s judgement is likely to be impaired”. I’m sure same precautions apply to other health professionals.

But when does the normal behaviour of a caring parent, child, or sibling cross over into therapy?

Here’s a situation to consider…

Imagine that you have a beloved 14 year-old daughter who has become depressed. You have tried your best to help her, but she is not getting better. She has become socially withdrawn and has lost weight. You realise, before it’s too late, that you need some assistance from another health professional, so you ask your colleagues to recommend someone for her to see, because you don’t want to send her to a friend as that may also confuse the therapeutic relationship. It’s difficult because you know almost everyone in the local area who works in adolescent mental health.

You go to the family doctor (well done for having one if you are a GP yourself!)  who obediently refers your daughter to the child and adolescent psychiatrist you’ve been recommended by colleagues The psychiatrist decides your daughter is at risk of an eating disorder and wants to start her on medications for her depression. You disagree. Medications are not your preference for her, and you feel psychological intervention should be the first step. You think she has lost weight because of her depression not because of an eating disorder. You remove your child from his care and decide that you can look after her yourself.

This might be where the problems really begin

Once we’ve sought outside help, what should we do if we observe our family members, especially our children, receiving what we consider to be sub-optimal care? Do we lose our rights as a parent to make decisions about care because we also happen to be health professionals?

When the person in question is our own child, we are actually at some personal and professional risk. If we remove them from care on the grounds that we are dissatisfied with the care that they are receiving we may not be being objective in our decision making, we could be risking not only being reported as a neglectful, but also as a professional for professional misconduct.

What can we do?

We need to remember that we may not have all the information necessary to make a comprehensive treatment plan. Our child may not have been completely honest with us about tricky things like sexual history, abuse, drug and alcohol history or suicidality. They may be protecting us in a way that they would not need to protect an outside observer - or protecting themselves from our distress.

It’s equally important to remember that as a parent we are entitled to get a second opinion (via our GP) if we do not agree with the first assessment.

That said, there may also come a time when what we need to do is trust and accept the advice of other health professionals and understand that, with our own emotional involvement, objectivity may be out of reach. That doesn’t mean we can’t still be the (informed and concerned) parent in the story, we just can’t be the treating professional.

 

References

Guidelines for Self-Treatment and Treatment of Family Members Medical Council of NSW  Version 6 2014 https://www.mcnsw.org.au/sites/default/files/procedure_-_guidelines_for_self-treatment_and_treating_family_members_pdf.pdf

Good Medical PracticeA Code of Conduct for Doctors in Australia, Medical Board of Australia/AHPRA (2009) https://www.medicalboard.gov.au/codes-guidelines-policies/code-of-conduct.aspx

General Practice Registrars Position Statement on providing care to practice staff and other colleagues https://gpra.org.au/2019/03/08/gpra-position-statement-s02/ 

Australian Psychological Society Code of Ethics https://psychology.org.au/getmedia/d873e0db-7490-46de-bb57-c31bb1553025/18aps-code-of-ethics.pdf

 

 

{{commentCount}} comment(s). You must be logged in and AHPRA verified to view and comment. LOG IN
Dr Jan Orman

Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

View more

The latest healthcare news from medcast

Strategies for surviving the news
Strategies for surviving the news

“Mass shootings are part of the American landscape….”

OA of the hip: The HIT Trial
OA of the hip: The HIT Trial

Osteoarthritis is by far and away the most common form of arthritis in Australia.

Clinical Opal #14 - CVD risk and statins in patients with CKD
Clinical Opal #14 - CVD risk and statins in patients with CKD

Graeme, a 64-year-old retired builder, presented to you for repeat prescriptions two weeks previously as a new patient to the practice...

Clinical Opal #13 - 41 year old with hip pain
Clinical Opal #13 - 41 year old with hip pain

Zoe is a 41-year-old graphic designer who presents to you with right hip pain...

Clinical Opal #12 - Deterioration post abdominoplasty
Clinical Opal #12 - Deterioration post abdominoplasty

Gail is a 63 year old post abdominoplasty who is complaining of tingling lips, abdominal cramping and watery eyes...

What makes a mental health app work?
What makes a mental health app work?

Clinicians I talk to often say that they recommend mental health apps all the time, but they find that even the most enthusiastic users seem to disengage pretty quickly.

GP Educational Intervention Improves Patient Care and My Health Record Usage with Potential to Save Government Millions
GP Educational Intervention Improves Patient Care and My Health Record Usage with Potential to Save Government Millions

A two-year study titled CHIME-GP was carried out by Medcast and the University of Wollongong. It has shown that educating GPs about potentially inappropriate or unnecessary medicines, imaging and pathology test ordering in the context of using the My...

More than a race: Medcast takes on the Shitbox Rally – Autumn 2022
More than a race: Medcast takes on the Shitbox Rally – Autumn 2022

From Wollongong, NSW to Mackay, QLD in 7 days. Medcast’s own team, Tyre Kickers, are taking on Shitbox Rally – Autumn 2022.

Clinical Opal #11 - SGLT2i-related DKA
Clinical Opal #11 - SGLT2i-related DKA

Terese is a 64-year-old retired teacher who has a 12 year history of type 2 diabetes. She also has hypertension...

Have you lost your mojo?
Have you lost your mojo?

I’m pretty sure I’ve lost mine. I lost it in the early part of 2021 and haven’t laid eyes on it since.

Promoting reproductive choice in primary care
Promoting reproductive choice in primary care

The Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) - a network for professionals working with women to optimise reproductive health

How Doctors Think
How Doctors Think

In this short video from the 2022 'Not to be missed' webinar series, Dr Simon Morgan provides some insights into how Doctors think.

Are we all ok?
Are we all ok?

Often OK is the very best I can do (especially lately), and I try to be grateful for that, but wouldn’t it be nice to be more than OK, to be flourishing, for a little more of the time! I hope I don’t have to wait for the world to be a better place be...

Clinical Opal #10 - Pre-conception care
Clinical Opal #10 - Pre-conception care

Kelly, aged 28, presents for an appointment as she is planning a pregnancy with her husband. She has no significant medical history, is nulliparous, is a non-smoker, has normal body weight, maintains a healthy diet and exercise routine, and has a con...

How connecting to my Aboriginality helps me stay strong
How connecting to my Aboriginality helps me stay strong

Being connected to your Aboriginal heritage can bring fulfilment and a sense of identity and culture but what about wellbeing?

Navigating the consultation
Navigating the consultation

At the core of general practice is the consultation.  In its simplest form, the consultation can be regarded as the sharing of information between patient and doctor in order to facilitate both a common understanding and a plan of management.

Clinical Opal #9 - 64 year old with fever and rigors
Clinical Opal #9 - 64 year old with fever and rigors

Joan is a 64-year-old hospital cleaner who presents to you one morning feeling 'dreadful'. Joan has a past history of well controlled diabetes and takes metformin 500mg bd.

Blended care – the future of therapy?
Blended care – the future of therapy?

Psychologists and their clients are perceiving online therapy in a new light since the pandemic. Although face-to-face therapy is once again possible, psychologists are opting for a mix of in-person and online therapy as the demand for care grows. Mo...

Clinical Opal #8 - Myeloma
Clinical Opal #8 - Myeloma

Bob Georgiou, a 66-year-old retired university lecturer, presents to you with vague aches and pains, weight loss of a few kilograms and fatigue for the past couple of months.

The dilemma of treating the ones we love
The dilemma of treating the ones we love

As a health professional, we’re always going to be faced with the professional and personal dilemma of where and when to draw the line when it comes to advice or treatment of loved ones.

Join Medcast. It's free and you'll get instant access to essential healthcare news, research and more.

Already a member? Log In