How to Manage Giving Medical Advice to Friends as a Nurse or Doctor

November 28, 2022
“In general, people only ask for advice that they may not follow it; or, if they should follow it, that they may have somebody to blame for having given it.”
Alexandre Dumas, The Three Musketeers
I remember in one of my first doctoring classes in medical school, the preceptor advised that as time goes by, and your close friends and family endure more medical maladies, you will be put on the spot as these loved ones pick your brain on the right course of action. He could not have been more correct.
If you’re unsure of how to approach giving medical advice to friends as a nurse, physician, PA, or another health care professional, here are a few of my top tips.

A text notification lights up my screen. It’s my childhood (and lifelong) friend, Steve, with a medical question.

“Brian, I’ve got blood in my urine and bowel movements. Should I go to the emergency room?”

“Hey Steve – probably. But before you get in the car…did you eat beets last night?”

“Phew! Thanks man. Turning the car around now.”

Not all medical queries are quite as easy as this. But probably once a week, there’s a ding on my phone with a photo, or a “My kid’s got this,” or just someone looking for a vote of confidence in a decision they have made. What’s the best way to approach giving medical advice to friends and family? How can you do the best for those you care about without leading anyone astray?

1. Use your judgment

Your hands are tied. You get a snippet of information from a text message and are expected to come up with an assessment and plan. Maybe you have what you think is a friend’s medical history, you know some of the medications they take, but you get no physical exam, no imaging or labs. Just some info and a query. What can you do? 

The same thing you do every day! Do your best to synthesize a decision based on all the available information. It’s up to you to decide how much you want to prod about sensitive topics (e.g. pregnancy, drug use, sexual activity). 

If it’s an easy question, give a pointed answer without conditions. Things like, “Should I finish my antibiotics?” or “Should I keep my febrile child home today?” The answer is yes!

2. Spell out what is likely to happen at the clinic or emergency department

Steve (from above) sent me this one not too long ago:

“Andy choked on a coin – coughed it up. Still some blood in his spit but he is breathing and feeling fine. Should we go in?”

A little trickier this time around. I certainly don’t want my friend’s son to suffer because of a judgment call that I made.

So, in this instance, I tell him some things to think about:

“Are you sure this is the only thing he swallowed? Coins travel in packs – could there be another one in there? They will probably shoot a chest X-ray and if it’s fine, and he looks good, they will send him home. If he has any breathing problems, I’d definitely go in. If you are worried, getting everything ruled out there will give you peace of mind.”  

You don’t always have to make a “yea or nay” decision. 

3. It’s okay to plead ignorance

When someone asks me something about their parent who has a complicated medical history, it becomes more and more difficult to make a diagnosis and recommendation. If ever I feel uncomfortable or uncertain, I simply let them know how I feel.

“Sounds like maybe his UTI is making him a little confused, but who knows – it could be a stroke, especially if it was sudden. I really can’t say, but what I’d do is…”

4. …send them to the ED when in doubt

No one will fault you for being very conservative. While you certainly don’t want to send every hangnail and splinter to the emergency room, in order to get “proper” medical care, this is the place to go.

In my experience, friends have gone to the ED, realized the wait time, and decided, “This is not emergent,” and made a clinic appointment for the next day.

5. Consider your audience

A medical concern from your most stoic friend should be interpreted differently than a request from your hypochondriac sister-in-law. If the stoic is worried, then you probably should be, too. If the worrier is worrying, then there might be nothing to worry about. But on the other hand, they might need the assurance of a work-up of sorts to tell them they are all right.

6. “Your job is to be his son, not his doctor”

With my own father nearly in extremis at the hospital, days before my medical school graduation, everyone was turning to me. “Is dad going to make it? What do we do?”

You can certainly serve as an advocate or medical translator for a friend or family member in need, but don’t let the line blur to the point where you try to take it upon yourself to diagnose and treat. Sometimes your job is merely to be supportive and to shed your role as a clinician. Read the room, and see what’s being asked of you at the moment.

7. Find compassion for the repeat offenders

Some friends or family might use this “free service” of yours more than others. Are their requests infringing on your personal life? Are you getting needless texts in the middle of the night? Is the phone disturbing your dinner on a nightly basis?

As long as things haven’t gotten to this extreme, I see giving medical advice to friends and family as an implicit part of the training I received. It’s my duty to educate, inform, and guide. And it’s easy to be sweet and friendly in a text message, even if you aren’t smiling on the outside. A heartfelt emoji and some empathetic words go a long way.

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By Brian Radvansky, MD

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