Your spouse/partner gets a skin infection and needs antibiotics: is it ethical for you to prescribe for them? No: such treatment rarely leads to comprehensive care.

It is within the natural and acquired disposition of physicians to help patients with their illnesses. When the patient is a spouse or partner with a skin infection, the tendency to want to initiate antibiotic therapy is understandable. This inclination is motivated by genuine concern for the partner, but it may also be fueled by the daily habit of intervention and treatment. Other possible reasons include the easy accessibility of a house call and prescription drugs, a desire to reduce the inconvenience of the partner having to arrange a clinic visit, a desire to eliminate the paperwork of insurance forms or bills, or an attempt to minimize work for overworked colleagues.1 Such treatment, however, may violate common principles of ethics and good clinical practice. Treating a skin infection is not, of course, the equivalent of administering cardiopulmonary resuscitation, the Heimlich maneuver, or indeed, any immediately lifesaving procedure to a partner for an emergent medical problem. In these clinical situations, lifesaving intervention is clearly appropriate. In treating a skin infection, however, the potential is there for inadequate diagnosis and mismanagement. This can occur for several reasons. First, a partner-physician relationship is rarely conducive to the delivery of comprehensive medical care because many of the inherent features of a good physician-patient relationship are often sidelined. For example, the quality of care is higher when a physician maintains a detached and impersonal judgment of a patient.2 Partner intimacy makes this inherently difficult. Second, because of the very personal partner bond, the physician may assume—incorrectly—an awareness of all the medical details of the infection simply because of the daily cohabitation and presumed understanding of the partner. As a result, relevant clinical features, such as cause, circumstances, and duration of the skin infection, may be assumed, inferred, or even ignored. Third, what if the skin infection is a manifestation of a sexually transmitted disorder or part of a systemic illness? Can an objective examination of the partner really be conducted in this situation? For better or worse, house calls are not part of physicians' routine training or daily experiences. Denying a partner a full medical assessment—a thorough history taking, a full physical examination, and suitable laboratory testing—means that the physician is providing substandard medical care. Finally, other essential features may be overlooked in treating a partner. These include formal follow-up assessments, monitoring adverse reactions, assessing compliance, and objectively reassessing for poor or unpredictable outcomes. I have often received calls from physicians who have treated their partners with 1 antibiotic, then changed to another antibiotic for reasons of inefficacy or because of adverse effects, leaving the partner with an unsure or incomplete outcome. They ask me, “Could you treat my partner, please?” Was it the wrong diagnosis or antibiotic, the unassessed compliance to therapy, or the lack of appropriate follow-up and corollary testing that resulted in the poor clinical outcome? Clearly, physicians should avoid treating partners' conditions except in emergencies.3(p12)