Lilla's surgical outcome was excellent, and Dr. Pivnick maintains that the experience made her relationship with Dr. Kerr stronger. "Not because she did the surgery, but how she handled it," she explained. "She became almost like a family member."
Dr. Kerr noted that a chief benefit of having friends as patients is an underlying sense of trust, the notion that, "you will do the very best for them or their child because of that relationship. Because you know them, you might know their needs a little bit more, their personality types, their viewpoints, and how they're likely to react to certain things."
However, certain circumstances can jeopardize such a tightly knit relationship. If something goes wrong, "your emotional investment might make it more difficult for you to be objective and handle things in a professional manner, particularly in [an operating room] situation," Dr. Kerr said.
Providing medical care to friends also can complicate efforts to preserve patient confidentiality. "It's that much more difficult to maintain that if you see people in a social setting or you're close to them emotionally," she said.
When friends of Dr. Kerr require invasive ophthalmologic care "I certainly tell them about other people in the community who do what I do so they feel like they have options," she added. "Having said that, I would not do anything invasive on my own children. I would certainly draw that line."
A Mark of Honor
Dr. Faith T. Fitzgerald considers it a mark of honor to provide medical care for friends.
"Almost by definition your friends know your flaws," said Dr. Fitzgerald, a professor of internal medicine at the University of California, Davis. You can feel comfortable telling your friends things you couldn't tell anybody else, knowing that they trust you, she said. "It's a deeper honor to be allowed to take care of your friends, because they know everything that's wrong with you in a characterologic sense and [about] decisions you made in the past."
One of her longtime patients is a close friend who also is a physician. When he makes an office appointment, they share what she calls a "mutual understanding, which allows both of us to go directly to the point. There aren't that many hidden parts of either my skills, knowledge, and adeptness, or his family life, his stresses and strains. In that sense, it is a more revelatory and facilitated interaction."
Another friendwho is not her patientrecently designated Dr. Fitzgerald as her durable power of attorney before undergoing cardiovascular surgery. Dr. Fitzgerald found herself getting input from members of her friend's large, extended family, from the cardiovascular surgeons, and from the physicians in the ICU. For her, the question became, whom do I represent today?
"Was I being my doctor self or was I being a family member because I am an adopted member of their family?" she asked. "Or was I being a patient advocate? Sometimes I had to wonder: Which of these roads do I need to take here if I thought something wasn't going as well as expected? That negotiation is not easy."
Several years ago, one of her patients, who was a friend and former lobbyist, developed myeloid metaplasia and began a steady decline. Around the same time, the administrators from a nearby school district he had once represented notified the man that they were naming a school in his honor and invited him to attend the ceremony.
That gesture "made him most proud," she recalled. The problem was that the man was on the brink of death. His son called Dr. Fitzgerald and asked, "Is there any way we could take him down to the ceremony?"
"Why don't you rent an RV?" Dr. Fitzgerald suggested. "That way, he could be lying in a bed and there could be people with him." The family ended up buying a recreational vehicle, but the man died about a week before the ceremony.
Three years later, Dr. Fitzgerald phoned the man's son to ask his advice on how to rent an RV. She needed one for her mother, who was frail from the late stages of Parkinson's disease but wanted to accompany her daughter on a drive to San Diego.
He told her not to worry; he'd take care of it, Dr. Fitzgerald recalled. "The next day, I came to my house and in front was parked this enormous RV. [He'd] had it mechanically checked out, filled up the tank with gas, and drove it to my house so I could use it for my mother."