- © 2007 Canadian Medical Association or its licensors
We all know that family members are prone to making demands on relatives who happen to be physicians. I've had an aunt ask me if I could get her a faster MRI. My father asked if I'd sign a form warranting special authorization for a pricey prescription drug. A cousin asked if I could expedite a referral to an orthopedic surgeon. To all these people I offer my stock response: I can't do that. It would be unethical.
Met with such an answer, it's probably predictable that they would, to a man, not get it. All of them asked again, but in a different way, starting off with, “But you don't understand….” In other words, they think it only natural to use their connections — in this case, me — and get what they want. Since I'm a doctor, they reason, they can use what God has only naturally given them to use.
The world works this way, I understand that. Who you know and all that. The problem is, I don't work like that. None of us should.
I explain how I'm not supposed to treat my own family, that it's against the rules. The smart ones say that I'm not actually treating them, I'm just accelerating a referral for them, or I'm allowing them to have a drug that was already prescribed to them. Again, they don't get it. They think connections matter. When backed up against the wall by all this importuning, I use my iron-clad defence: if I were ever investigated, I could lose my licence. And I'm unwilling to do anything that would cause me to lose my licence.
I've deflected family members in this way countless times. I've even gotten good at it. But something happened recently that wasn't easy, that has stayed with me, and even though I know I'm doing the right thing, I'm still questioning myself.
My brother is a professional sports player. He's getting on in years and his conditioning this summer hasn't been spectacular. He felt he needed an edge, so he asked me to prescribe him steroids.
I was shocked. My brother? The brother I've looked up to all my life? Wants to take something illegal? Wants me to help him obtain something that is illegal?
I said no, that I wouldn't do anything illegal. It was hard; I knew what was on the line, his livelihood. He has two children, a wife, a new house, big bills. But I knew it was wrong and I applied this litmus test: would I do it for a patient of mine? No.
He was persistent. He seized on the word “illegal” — he just didn't get it — and bargained for testosterone, calling it “Test.” That's not illegal, he said. He's right. It's not illegal, but ethically I can only prescribe it under certain conditions and gaining a step or pushing more weight on the bench press is not one of those. I told him I could lose my licence if I gave a dubious substance to a family member, that it wasn't in the best interests of his health anyway, that he should get in shape the old-fashioned way.
I didn't add, but I thought, that if you want performance-enhancing drugs, get them from someone else. Weren't we brothers? Wouldn't we help each other in any way we could, not act as drug pushers? I was a little angry that he'd even dare to ask me to do something so shady. But then I remembered: he was just a family member using his connections. No different.
He was angry; he didn't understand why I couldn't help him. He said, “But I'd do it for you!” I used the broken-record technique, reiterating that I could lose my licence and that my livelihood would be lost. It was hard; he's done a lot for me. But I think I did a lot for him by saying no. I think.
— Dr. Ursus