In the early days of medical school, a professor cautioned us: “Never prescribe for someone who isn’t your patient.” He recounted an instance of prescribing a simple antibiotic for a friend who subsequently suffered from Stevens-Johnson syndrome, a traumatic event that troubled him for years. His lesson was unmistakable: There exists a distinct line between providing care and inflicting harm.

Now, fifteen years later, we are more aware of just how indistinct that line can be.

“First, do no harm” may appear simple until you find yourself as the doctor that everyone recognizes. Friends share images of rashes. A neighbor casually requests that you fill out a form “just this once.” A bank teller rolls up a pant leg to reveal a concerning ulcer after noticing your hospital ID. Although these requests seem trivial, the implications are never minor.

Every informal consultation carries with it an unspoken evaluation:
What if I overlook something? What if my attempt to assist hinders true care? What if my reassurance prevents someone from consulting their physician?

Moreover, we function within a flawed system, facing long wait times, prolonged calls on hold, and prior authorizations that can wear people down. Occasionally, “doing no harm” can translate to calling in a prescription refill for a medication that a friend has relied on for years, as access fails them yet again.

The mental acrobatics of establishing boundaries are seldom recognized. As one of us (AA) frequently states when approached at the playground: “Are you asking me as a friend, a mom, or a doctor?” (Recognizing fully that the answer alters nothing.)

The complexity escalates when the roles reverse, becoming the family member. Being the “doctor in the family” is a complicated privilege. You are fluent in hospital terminology, transforming into the interpreter, the advocate, the early-warning system. You must discern when to be concerned and when not to.

But how do you advocate without risking being labeled “that family”?

Do you silence the IV pump to spare everyone’s sanity, fearing you may be overstepping?

Do you request clarification from the residents, or accept an inadequate explanation to maintain goodwill?

Physicians are trained to foresee disaster; this is part of patient safety. Yet, that same vigilance can backfire when a loved one becomes the patient. We search for signs of deterioration that others may not perceive. We catch unease in a consultant’s voice that may elude others.

We become both the guardian of hope and its most fervent skeptic.

Navigating these two realms (caregiver and beloved) necessitates emotional adaptability. We set aside our own fears to exude calmness. We take on the medical trauma for others. There is little room for our own grief, anger, or vulnerability.

This burden is unseen and substantial.

Yet, there is wonder.

One of us recently witnessed her mother leave the hospital following a robotic Whipple, an event that feels nothing less than miraculous. In those instances, being a small part of this enormous, flawed system feels purposeful. Valuable. Affirming.

We stand alongside the bedside, both humbled and grateful when the system excels. When well-coordinated care becomes harmonious. When the talent of a surgeon, the attentiveness of a nurse, and the proficiency of a pharmacist converge to rescue someone dear to us.

It reminds us of the reasons we entered those hospital doors in the beginning.

Because when medicine succeeds (when it genuinely succeeds), it is awe-inspiring.

Rebecca Margolis is a pediatric anesthesiologist. Alyson Axelrod is an interventional physiatrist.