Self-treatment or treatment of immediate family members

Kaiser Permanente concurs with the recommendation of the American Medical Association (AMA) and the Washington State Medical Association that in order to avoid the potential for ethical conflicts, providers should not treat themselves or their immediate family members.

Kaiser Permanente prohibits a provider from prescribing controlled substances for his or her own use and from prescribing controlled substances to a member of his or her immediate family, except in an emergency situation or isolated settings where there is no qualified physician available within a reasonable proximity. In addition, Kaiser Permanente medical offices will not accept orders or prescriptions from providers ordering services for themselves or an immediate family member.

The purpose of this policy is to avoid potential risks related to conflict of interest, lost objectivity, and invasion of privacy. Professional objectivity may be compromised and/or a conflict of interest may exist when the provider, or an immediate family member, is the patient. The provider's personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Immediate family members may be reluctant to state their preference for another provider or decline a recommendation for fear of offending the provider. In particular, minor children may not feel comfortable refusing care from their parents. Likewise, providers may feel obligated to provide care to immediate family members even if they feel uncomfortable.

There are also privacy concerns that must be considered. Advances in technology have resulted in patient health records that are more complete and may contain more information than paper charts. Provider treatment of self or immediate family members may result in access to information that would be a violation of patient privacy and/or Kaiser Permanente policy.

Kaiser Permanente recognizes that there are occasions where it may be appropriate to treat immediate family members that should be limited to:

• Emergency situations or if there is no other proper medical care available at the time of care.
• Immediate care for minor conditions until the patient finds a qualified physician.

All recognized follow-up care should be communicated and arranged with the provider who has responsibility for the ongoing care of the member, or the consulting provider involved in the member's immediate care episode.

Definitions

For the purpose of this policy the following terms are defined as:

Immediate family members:

• Spouse or partner
• Natural or adoptive parent, child, or sibling
• Stepparent, stepchild, stepbrother, or stepsister
• Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law
• Grandparent or grandchild
• Spouse of grandparent or grandchild
• Any other individual to whom the provider has personal or emotional involvement that may render the provider unable to exercise objective professional judgment in reaching diagnostic or therapeutic decisions.

Provider includes:

• Pharmacists
• Physicians
• Physician assistants
• Nurse practitioners
• Nurse midwives
• Registered nurses
• Licensed practical nurses
• Nurse anesthetists
• Psychologists
• Social workers
• Medical assistants
• Physical therapists
• Occupational therapists
• Speech therapists

Treating encompasses the performance of any controlled act including:

• Ordering and performing tests
• Making and communicating a diagnosis
• Prescribing medications

It does not include the monitoring of a condition that may be conducted by unlicensed individuals.

Emergency situation:

• Exists when an individual is experiencing severe suffering, or is at risk of sustaining serious bodily harm if medical intervention is not promptly provided and no other proper medical care is available.

Minor condition:

• Generally a non-urgent, non-serious condition that requires only short-term, routine care, and is not likely to be an indication of, or lead to, a more serious condition.