The College recently received a referral from Medical Services Branch (MSB) regarding several physicians who submitted billings for services provided to patients who are part of their own family unit.

When a billing is received by MSB, it is assumed that such a service has been delivered, as physicians are personally responsible for the accuracy of the billings submitted by their office/billing clerk.

The CPSS Code of Conduct states:

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m. Maintain professional boundaries.  That includes refraining from providing care to individuals where a dual relationship* exists and objectivity may be challenged; in circumstances where refraining is not reasonably possible, ensure care provided is transparent, objective and defensible

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*Where the “dual relationship” is defined as: when multiple roles (personal, professional, business or social) exist between a physician and a patient.

The CPSS Code of Ethics states:

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7.   Limit treatment of yourself, your immediate family, or anyone with whom you have a similarly close relationship to minor or emergency interventions and only when another physician is not readily available; there should be no fee for such treatment

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The CMPA also addresses this issue in their document: Know the rules, avoid the risks: Treating family and friends.

The College understands that billing mistakes can occasionally happen, despite the fact that physicians are expected to review their billings prior to submission to MSB.

The most recent referral included situations where the administration of vaccines in a clinic setting were assigned to the physician who was the family member, instead of the person administering the vaccine. The same appears to have happened with samples submitted to a lab. However, once the billing has been submitted, it can only be interpreted that the physician actually delivered the service to a member of their family unit.

Physicians often consider treating family members.  Unfortunately treating family members removes the objectivity and distance necessary in a physician-patient relationship. Even a benign treatment like administering a vaccination may have dire consequences if a complication, for example anaphylaxis, should occur.

Sometimes physicians consider engaging informal consultations with colleagues or friends for treatment of family members.  This strategy is also not recommended unless it follows the formal consultation process.

We strongly recommend that physicians refrain from prescribing or treating family members.  If a physician continues to treat or prescribe to family members, this issue could be seen as unprofessional conduct and may be referred to discipline.