THE PRACTICE of physicians' caring medically for their families is not new and appears to be common. In the only published empirical data on this subject,1 83% of 465 practicing physicians in a community teaching hospital had prescribed medications for family members; 80% had diagnosed illnesses; 72% had examined family members; 17% had attended family members in the hospital; and 11% had operated on family members. Most (59%) had previously refused a family member's request for medical care; 48% had referred the patient for whom they had made their "most important diagnosis."1 Incidence, quality effects, process and outcome of care, and the utility and effectiveness of the physician-patient relationship when physician and patient are family remain unknown.
The practice of physicians' treating their own families raises ethical concerns, including when to breach confidentiality or obtain advance directives; how to secure informed consent, assess decisionmaking capacity, or give end-of-life care;