The treatment of one’s self, family, and colleagues and being a physician–patient are aspects of clinical practice that are often not taught in medical schools or during residency training.1 All over the world, physicians may treat their friends or family members.2 However, in several countries, including ones in the Middle East, hospitals have established on-site primary care clinics wherein physicians treat the hospital’s employees and their family members. For those of us who previously worked in the UK, this is an issue that we rarely ever came across as each employee would have their own designated primary care clinician at a different health centre. All four of us work in a hospital that has a staff clinic.
Ethical and practical challenges
Running a staff clinic and treating (medical and non-medical) work colleagues and their family members is a privilege but some physicians may feel trepidation, especially when treating another doctor. Concerns include whether they are being judged, whether they are good enough, or what might happen if they miss a diagnosis or make a mistake.3 We suggest that seeing colleagues also presents the following ethical and practical challenges:
Allocating sick leave. The physician has to balance the patient’s (employee’s) interest with the needs of the employer (the hospital) when prescribing paid time off for sickness. This can be contentious, especially in the case of minor illness or when minimum staffing levels need to be maintained in clinical areas.
The patient may request investigations and referrals that do not follow the principles of evidence-based medicine.
Asking personal and sensitive questions and performing intimate examinations can be awkward and embarrassing for both physician and patient. This may result in the physician avoiding asking these questions or performing a necessary examination. Also, the patient may not seek medical advice if they think that they need to expose intimate parts of their body.
The physician may be asked for medical advice outside of the clinic room. This may result in the physician not giving appropriate advice due to not being in the correct frame of mind or simply because they do not have the patient’s medical records in front of them. Patients may not disclose their full medical history in these settings, particularly if it pertains to sensitive issues such as sexual or mental health.4
When two clinicians are in a doctor–patient relationship, the treating physician may wrongly assume that the patient knows what to do. Conversely, the patient may think they know what is wrong with them and make a wrong self-diagnosis that affects the doctor’s management plan.
The treating physician may also feel pressure to over-investigate and request inappropriate tests because of the anxiety of missing a diagnosis and harming their reputation among colleagues.
There are strict regulations that exist in many countries that discourage or prohibit physicians from treating friends and family. The General Medical Council in the UK has provided clear guidance on how to uphold professional standards, ensure objectivity in clinical decision making, and protect both patient safety and the integrity of the doctor–patient relationship: ‘Good medical practice states that “wherever possible you should avoid providing medical care to yourself or anyone with whom you have a close personal relationship”.’ 5
“In many countries, there does not appear to be any guidance for doctors who treat friends and colleagues on how to navigate this ethically challenging scenario. We recommend that every country has clear guidance on how clinicians can navigate this challenging area of medical practice.”
The Medical and Dental Defence Union of Scotland provides medical indemnity for UK healthcare workers and gives the following advice when treating work colleagues: ‘No doubt we can develop close relationships with colleagues, working together in sometimes intense circumstances, day after day. Often we get to know a lot about their personal lives and problems. It is important to recognise that these close personal relationships can inhibit the ability of a doctor or dentist to make any potential clinical decision objectively.’
6
According to the medical code of ethics in Saudi Arabia, a healthcare practitioner is allowed to refuse to treat a patient in non-emergency situations for personal or professional reasons that might compromise the quality of care. This is allowed as long as it does not harm the patient’s health and there is another qualified practitioner available to treat the patient.7 However, it may be difficult to decline to treat a friend or colleague from a cultural point of view because of the emphasis placed on helping others in society.
Recommendations for treating colleagues
In many countries, there does not appear to be any guidance for doctors who treat friends and colleagues on how to navigate this ethically challenging scenario.8,9 We recommend that every country has clear guidance on how clinicians can navigate this challenging area of medical practice. We would advocate the following advice when treating colleagues:
Try to avoid treating close work colleagues or friends unless there is an urgent clinical need to do so.
Try to avoid giving medical advice outside of the clinic room or seeing patients without an appointment. Ideally, you should politely request that the person makes a formal appointment to discuss their issue as the care the person receives is likely to be of a higher standard. It is important to set boundaries early on in the relationship as it may be more difficult to establish this later down the line once a precedent has been set.
The treating physician should be in a frame of mind that the person in front of them is a patient and not their friend or a physician. If there are any sensitive questions that need to be asked or intimate examinations that need to be performed, the physician should explain that this is a routine part of the consultation that needs to be done and ask whether the patient would be happier to see another physician if they feel uncomfortable.
Strike a balance between avoiding assumptions about the patient’s knowledge of their condition and insulting them by giving them very basic information.4 You might preface advice by saying ‘As you may know’ or ‘You already know this, but I would like to reiterate to you that you should’, this will allow the doctor to speak their mind while minimising the risk that the patient will get upset at their perceived lack of knowledge.
Be clear in giving the proposed management plan and consider saying something like, ‘This is what I think we should do but I am happy to listen to your opinion and we can come to a mutually agreed on plan.’
Reassure the patient that everything discussed within the confines of the consulting room will be kept confidential (as long as there are no public disclosure duties such as safeguarding concerns). If the patient finds out that the physician has divulged any information to others (even if it is not sensitive information), this can irreparably damage the doctor–patient relationship. The American Medical Association’s Code of Medical Ethics advises: ‘Respect the physical and informational privacy of physician–patients. Discuss how to respond to inquiries about the physician–patient’s medical care from colleagues. Recognize that special measures may be needed to ensure privacy.’ 10
If the patient asks for investigations that are inappropriate, politely explain the reasons why you cannot agree to such requests and that you are doing it sincerely for their best interests and according to best practice guidance.
It is crucial that any doctor–patient consultations are documented objectively and contemporaneously in the medical records.
Treating work colleagues can pose ethical and professional challenges to the treating clinician. We think that the above guidance may reduce the risk of any unwanted consequences, protect professional relationships, and ensure that the patient receives the best possible care. Clear professional guidance from regulatory bodies around the world would be welcome.
- © British Journal of General Practice 2026
