Patients as friends, friends as patients

Doctors can practice medicine anywhere in the world as long as they have a place to practice and a stethoscope. The challenge is learning a local health system and its rules and regulations. So the main obstacle which faces IMGs is how to integrate themselves into a different health system and to understand and apply its rules and regulations. Where I grew up in Iraq, and perhaps in all non-western countries, it is common for doctors to look after their relatives and friends. Friends can be doctors' patients and their patients can be their friends. It is normal back home to see a doctor and his/her patient hanging out, dining out and even traveling together, moreover it is not uncommon to see a doctor married to his patient or her patient A doctor who tries to set boundaries with his patients or tries to be purely professional would look weird and eccentric. Culturally, not doing what other doctors did, would be perceived as arrogance and grandiosity. O Canada When I came to Canada, I was excited and pleased with many rules— specifically with the rule that prevents doctors from treating their friends and relatives and I easily accommodated and embraced it. But, despite my hyper vigilance, a few things slipped away from my hands early in my practice. . . . Mr. Ali is a friend of my friend who asked me if he could be my patient. I embarrassingly agreed. In one of his visits, he asked for Tylenol 3s and when I asked him what it was for, his answer was to send them to his brother back home. I, of course, declined it and asked him not to repeat that request again. He never came back to the clinic. Mrs. V, a married lady, lived with her husband and kids. She was a relative of a friend of mine and she asked for a letter stating that she was a single woman for some financial gain. I refused and she left the office and never returned. The main problem I faced was that people from the same culture as me think we are friends. It is difficult for them to understand the boundaries that I set from Day 1; they feel that they are entitled. I understand that most of them have good intentions but sometimes good intentions can be harmful. They call the office to see me for same-day care and if my schedule is full, they ask the staff for my cellphone number because, as they say, “he is my friend.” When the staff refuses to pass on my number they spew their anger in an insulting way. A few years ago, a person knocked on my door at home repeatedly and heavily at night. My wife opened the door and there was a boy there who handed my wife a plate of food and told her: “This is from my family to Dr. J. He is our doctor and we learned that he lives here in the same street that we live on.” My wife hesitantly took the plate and thanked him. Again, culturally, it is an unpleasant action to reject a gift. When I learned about that I sent a letter to them and thanked them for their gesture but I advised them that I prefer our relationship to stay in the clinic and not outside it. I elaborated on how it is better and important for doctor-patient relationships to stay professional. I have never seen them thereafter—apparently they received the letter. After I applied and enforced this rule I haven't had any major problems in the past few years. Perhaps and unfortunately I am seen as less likable by people from my culture but I would prefer being unlikeable and hassle free than the opposite. We need to teach other IMGs like me more than just the medicine but also the rules and ways of Canada and we need to affirm the statement: "Your friend can’t be your patient and your patient can’t be your friend." Dr. Jabir Jassam is a family physician who works at Health Treasure Medical Center in Ottawa.

Patients as friends, friends as patients

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