I come from a long line of physicians. My grandfather was a pioneer in pharmacy and biochemistry, so influential that a museum now bears his name. My father, also a doctor, was cut from a very different cloth. I have written before about our strained relationship and the heavy expectations placed on a child born into a family with a reputation to uphold. Those tensions shaped my early views on medicine, including my strong opinions about treating family members.

In the 1960s and 70s, when regulations were looser and boundaries blurrier, my father practiced medicine with a firm rule: He refused to treat friends or relatives under any circumstances. Even when my mother asked him for help managing her anxiety, despite his being a psychiatrist, he declined. As a child, I saw this as selfishness. Why wouldn’t he help the person he loved most?

Only later did I understand that his refusal, though imperfectly explained, was rooted in legitimate concerns. He often cited fear of litigation, but he rarely articulated the deeper truth: Treating someone you love carries risks that extend far beyond the clinical.

A painful lesson

I learned this lesson the hard way.

When I earned my medical license, I was determined not to repeat my father’s rigidity. I wanted to help everyone I could, even outside the walls of my clinic. I tried to be thorough, taking histories, asking questions, but treating friends and family is inherently different. You assume you know their medical background. You assume you understand their habits, their risks, and their physiology. Those assumptions are dangerous.

My first painful lesson came when my grandfather’s sister developed what she described as arthritis pain. She complained of discomfort in her left shoulder, and at the time, I interpreted it through the narrow lens of musculoskeletal medicine. My father refused to prescribe anything. I, eager to help and armed with newly acquired samples of a non-steroidal anti-inflammatory drug, offered her the medication. Two days later, she died.

Rationally, I know the NSAID almost certainly had nothing to do with her death. She was in her eighties. The dose was small. But with the benefit of hindsight, I have often wondered whether her “arthritis” pain was something far more ominous, perhaps angina presenting atypically, or even the early signs of an impending heart attack. That possibility has haunted me for decades. Had I asked more questions about the nature of her pain? Had I considered cardiac causes instead of assuming a benign musculoskeletal explanation? Would a more thorough history have changed my decision? Did I unknowingly miss the warning signs of a much more serious condition?

This is the part of medicine we rarely talk about. Even when we do everything right, outcomes can go wrong. When the physician is a stranger, there is emotional distance. When the physician is a family member, that distance collapses. The guilt can be crushing. The family’s grief can turn into resentment. And the physician’s self-doubt can linger for a lifetime.

The Stevens-Johnson syndrome warning

A 2014 case that made national headlines illustrates this risk. A young mother, Yasmeen Castanada, developed Stevens-Johnson syndrome after taking leftover antibiotics given to her by a friend. Early media coverage focused on the dangers of sharing prescription medications. But the deeper truth is more unsettling: Even if the friend had been a licensed physician, the outcome could have been the same. Stevens-Johnson is rare, unpredictable, and often unpreventable. When such a reaction occurs in a loved one, the emotional fallout is profound.

Today, I practice in Florida, where prescribing medication requires establishing a formal patient-physician relationship and reviewing medical records. The law does not forbid treating family members, but it does impose guardrails. And so, I continue to wrestle with the question: When is it appropriate to treat someone you love?

The blurring of lines

Recently, this question became personal again. My wife developed severe sciatica and required an interventional procedure. She trusted only me to perform it. Legally, I had full access to her medical records. Clinically, I was confident in the procedure. But ethically, I hesitated. Would my desire to relieve her suffering cloud my judgment? Would I overlook something because I assumed I already knew her history? Would I push myself to act sooner, or more aggressively, because I could not bear to see her in pain?

These questions become even more complicated in my specialty, physiatry, where medications and interventions often take weeks to reach full effect. Patients frequently tell me, “It didn’t seem to work at first, but now it’s much better.” If I lived with those patients, hearing their daily frustrations, would I prematurely escalate therapy? Would I choose a riskier medication simply to ease their suffering sooner?

And this dilemma is not limited to family members. It can arise just as easily when treating employees. Even with a formal medical record and a proper patient-physician relationship, the emotional and practical pressures are similar. You see the employee every day. You hear about their symptoms in real time. There is no natural buffer, no scheduled follow-up visit two weeks later to assess progress. Instead, you are confronted with their discomfort daily, and the temptation to adjust treatment prematurely can be strong. The boundaries blur, not because of familial ties, but because of proximity, familiarity, and the unavoidable intertwining of professional and personal roles.

Navigating the ethics

The American Medical Association discourages treating family members except in emergencies, and for good reason. The boundaries blur. Objectivity erodes. Emotions interfere with clinical judgment. And the consequences (medical, ethical, and emotional) can be profound.

Yet the reality is more nuanced. Many of us do treat family members in some capacity. We answer questions. We offer guidance. We provide informal curbside consultations. The line between advice and treatment is not always clear.

So how do we navigate this ethically?

We start by acknowledging the risks, not only clinical risks, but emotional ones. We recognize that our desire to help can cloud our judgment. We understand that even perfect medical decisions can lead to imperfect outcomes. And we accept that when those outcomes affect someone we love, or someone we work with, the burden is heavier.

We also recognize that boundaries protect not only the patient but the physician. They preserve objectivity. They prevent resentment. They safeguard relationships.

Ultimately, the question is not simply whether we can treat family members or employees, but whether we should. The answer will vary from situation to situation, from physician to physician. But the ethical considerations remain universal.

Medicine is not practiced in a vacuum. It is practiced in the context of human relationships: messy, emotional, complicated relationships. When those relationships overlap with clinical care, the stakes rise.

As physicians, we must ask ourselves: When do the benefits outweigh the risks? And what risks (clinical, ethical, emotional) are we truly prepared to take?

Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness. 

Dr. Torres was born in Spain and grew up in Puerto Rico. He graduated from the University of Puerto Rico School of Medicine. Dr. Torres performed his physical medicine and rehabilitation residency at the Veterans Administration Hospital in San Juan before completing a musculoskeletal fellowship at Louisiana State University Medical Center in New Orleans. He served three years as a clinical instructor of medicine and assistant professor at LSU before joining Florida Spine Institute in Clearwater, Florida, where he is the medical director of the Wellness Program.

Dr. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine. He is a prolific writer and primarily interested in preventative medicine. He works with all of his patients to promote overall wellness.