January 20th’s NY Times, Science Section’s “Hard Cases” column, Too Close to a Patient for Comfort, makes the case, based on AMA guidelines and other sources, that objectivity in medical care may be compromised by doctor-friends. “Medical care supplied by a relative — or an old friend, or a trusted employee — just seems so logical. After all, who could care for you more? But that is just the problem…”

The article triggered 2 thoughts and a dilemma:

1. When I was too young to know about medicine, I remember hearing that a doctor could not do surgery on a family member. Might have been true—or not. A playmate was having surgery. She was 9.

2. In graduate school, the professor in “Techniques of Counseling” gave us a practical list of counseling do’s and don’ts followed by his saying something like: “Be forewarned: if you’re trying to counsel a family member, your emotions will dictate and you may forget this.”

If the emotional ties of friendship can interfere with doctors’ objectivity, how do we reconcile this when it comes to helping aging parents, the elders we care about, and ourselves?

Boomers and those older, remember doctors who knew your family, possibly made house calls, and definitely made hospital visits. It was more “warm and fuzzy” then. Today’s efficiencies, however, dictate something entirely different.

I hear people say “It’s not the doctor’s “bedside manner” that matters. Agree. Knowledge and expertise are most important. But it helps if we feel s/he cares about us, doesn’t it?

Three people immediately come to mind. They don’t have friends as their doctors; yet they’re confident in their doctor’s ability to is do what’s best for them and they feel a certain bond–perhaps a professional-type friendship. Another commonality: they make every effort to take care of themselves to the best of their ability. It appears doctors appreciate this.

1. Several weeks ago I reconnected with a friend, living in a large city in the west with excellent healthcare available. I was unaware that she has a serious, unusual vision problem. Asking about her doctor, she related she did the research and now has the best doctor–adding she was concerned that, because she’s now on Medicare, it would be a challenge finding a doctor who would take her. Then she said, laughingly, something like “When we met he told me he isn’t taking new patients, but I’m ‘vibrant’ so he’s making an exception.”

2. Sr. Advisor R, at 101, has obviously had many doctors over the years. This last year a new best ophthalmologist  (taking few new patients) has been doing his best to maintain her sight, which was rapidly worsening.

She was initially concerned that he thought “She’s old, I can’t do much.” R made him realize she takes very good care of herself (corroborated by the lab tests her primary care doctor sent), lives in her home by herself, and will do everything possible to maintain her independence. He, like her other doctors, respects that–and her. For several months there was no improvement. 12 weeks ago there was slight improvement in one eye. I drove her to her last appointment and there was even more improvement in that eye. The doctor was cautiously optimistic; said to be sure to call immediately if she noted any change–not to wait for her next appointment. He wasn’t a friend but he cared. R’s spirits lifted.

3. Next I check with my friend of decades, who had polio as a child. In her mid-70’s, she has seen countless doctors who were not friends. “Confidence in them,” she says, is a must or she finds a new doctor. She has made changes over the years, as allowed in her health plan.

And we learn a tip–

She writes thank you notes after each appointment. The notes aren’t a hidden agenda to make them like her, she says, but actually to let them know that she’s very appreciative of their help. In addition, reading her note must make them think about her again after her visit. “It puts you on a level that most patients aren’t on,” she says.

A tip for us personally? And for those we care for and about. .

Related: New England Journal of Medicine‘s May 2014: Ethical Challenges in Treating Friends and Family..