The Trusted Physician
A trusted personal physician is one of the most important relationships a distinguished family can cultivate. We discuss what makes the relationship work.
Among the relationships a distinguished family ought to cultivate with care, the one with a trusted personal physician is, in our firm view, second only to the relationship with the family's senior household staff. The physician knows things about the principal that very few others do, sees them in moments of vulnerability that no one else witnesses, and is in a position to alter the course of the principal's life by the quality of their counsel. Such a relationship cannot be assembled in haste, nor maintained inattentively.
A trusted personal physician is not, in the sense we mean, the same as a concierge medical service. The latter offers convenient access to clinicians who may be skilled but who do not, in the ordinary course of things, know the principal as a person. A trusted personal physician knows the principal's history, their habits, their family circumstances and their particular susceptibilities. They are willing to telephone, late on a Sunday, when the principal's spouse is unsure whether a symptom is serious. They know which specialist to recommend, and which to avoid, in any major centre the principal is likely to visit. They keep, somewhere private and well ordered, the record of the principal's medical history in enough detail that an unfamiliar physician encountered in extremis could be properly briefed within minutes.
Such relationships are, almost by definition, long. They are typically formed with a clinician of considerable seniority, often known to the family for many years before any formal arrangement is contemplated. They cannot be hurried into being, and they require, on both sides, a commitment of attention that does not always sit comfortably within the modern healthcare economy.
Medical information is among the most sensitive a family possesses. It is also, increasingly, the information most exposed to inadvertent disclosure, through electronic records, through staff at unfamiliar hospitals, through the well meaning circulation of correspondence among colleagues. On a number of occasions we have advised principals to maintain medical relationships in jurisdictions which afford stronger privacy protections than their primary residence, and to undertake significant procedures, where clinically appropriate, in settings chosen as much for their discretion as for their facilities.
There is no health without privacy, and no privacy in health that is not deliberately built and patiently defended.
Even the best generalist physician cannot, single handed, provide every form of expertise the principal may need over the course of a long life. Part of the function of the trusted physician is to know who else to call. The principal does not need to maintain a directory of leading specialists in every field; they need a physician who does. When a difficult question arises, the principal asks one person, and that person, drawing on relationships built over decades, ensures that the right second opinion is obtained, the right procedure recommended, and the right surgeon engaged. This is the form of medical care best suited to a principal's needs and most respectful of their time.
OfficeThe Discipline of the Principal's Diary
The private diary is the principal's most important document. We discuss the quiet disciplines that distinguish a well-kept diary from a busy one.
Read essay