Morgenstern, J. What would you do if this was your family member?, First10EM, August 15, 2022. Available at:
The question, “what would you do if this was your family member?”, rubs me the wrong way.
I hear it all the time. Patients ask this of their doctors. Colleagues ask it when debating controversial therapies. Superficially, it sounds benign, or perhaps even important, but I think the implications are awful.
The question implies that I regularly provide substandard care to my patients; that I hold some special treatments back just for the people I love most. Underlying this superficially reasonable question is an unhidden world of distrust.
I provide the same high quality care to every single patient I see. If I make a recommendation on a blog post, or to a patient I see, you can be damn sure that I would do the exact same thing for my mother or my son. That is the ethos of medicine.
The question “what would you do if this was your family member?” implies a divided world of medicine; a conflicted world of medicine; a world in which patients are arbitrarily treated differently. In such a world, patients would be right to distrust us. I don’t want to work in this world.
Of course, before assuming mistrust, I must ensure that I have not simply failed as a physician. Often, this question is simply intended to mean, “what would you do, doctor?”, which I think is a reasonable and important question.
In this context, I think the question reflects a failing of modern medicine. In the move away from paternalism, we have lost our ability to guide. Shared decision making and informed consent are wonderful tools, in their ideal form. However, too often in modern medicine, these tools are perverted into a form that serves more to protect the physician from liability than to discover the patient’s core values.
A 90 year old with advanced dementia is admitted to hospital. We describe the process of CPR and intubation. We sometimes talk about broken ribs (but please don’t). We talk about the bad outcomes. But then we stop, and ask “what do you want?” We force patients and family members to make almost impossible decisions without the benefit of our medical expertise and judgment.
In this context, the question “what would you do if this was your family member?” is simply a marker of a incomplete conversation. A sign that we have failed to effectively guide our patient through their difficult decision. The question provides us an opportunity to complete our unfinished task, but what happens to the patients who don’t ask? We shouldn’t have to be reminded to help guide our patients.
More frequently, I hear the question asked by colleagues. In this context, it bothers me, because I think it suggests the unstated, but troubling assumption that we reserve special treatment for special individuals.
For decisions I can control, I treat my patients exactly as I would treat my family. When deciding between oral and IV antibiotics, I treat every patient the same. I would suggest oral antibiotics to my mother, just like I do for all my patients. People frequently attempt to use this question as a trump card in evidence based medicine. When I discuss the significant uncertainty around thrombolytics for stroke, critics often throw this question in my face, as if the uncertainty would disappear if I was forced to treat a love one. Unfortunately, it doesn’t. The practice of evidence based medicine is hard. It eliminates the illusory black and white world that many clinicians find so comforting, but embracing uncertainty prevents certain mistakes.
For many aspects of healthcare that are out of my control, the question “what would you do if this was your family member?” is just depressing. That elderly cancer patient who has been sitting in the waiting room for 36 hours because there is no hospital bed – what would you do if that was your family member? The patient who can’t afford their medications; the patient with no home to be discharged to. What would you do if they were your family? Here, we are reminded that we do live in a divided world. Some patients are treated differently than others. I am not sure it helps for physicians to ask “what would you do if this was your family member?”, but I sure wish our CEOs and politicians would.
Either way, I hate the question, “what would you do if this was your family member?”. I would be thrilled to never hear it again.