Should I treat a patient that I know?

According to the Medical Council in its Guide to Professional Conduct and Ethics, doctors should not treat, prescribe, or issue sick certificates or reports for people with whom they have a close personal relationship, except in emergencies.

What counts as a ‘close personal relationship’ is not always straightforward and often needs to be assessed on a case-by-case basis. Such relationships may include family members, friends, colleagues, or even certain acquaintances. Even if you do not consider your relationship to be a close personal one, the key question is whether you can remain objective. Personal relationships can significantly interfere with clinical judgement and create a conflict of interest – for example, you may feel under pressure to provide a particular treatment or find it challenging to be impartial about their need for it.

There is also a risk that you may, consciously or unconsciously, prioritise the patient’s convenience or comfort over your usual balanced clinical approach. Likewise, the patient may also find it difficult to be completely honest with you about their symptoms and medical history, which could impact your ability to provide safe care.

A very low threshold should be applied when considering whether you can be completely objective. If you are referred a patient who you are close to, or a patient who you may not have a close personal relationship with, but where you cannot be sufficiently objective, it is advisable to highlight this, and sign post the patient to an alternative colleague or service. If there is no alternative, you should keep detailed records to show you have followed professional guidance and can justify any investigations or treatments. If you determine that you can be sufficiently objective, you may still wish to check whether the patient feels comfortable seeing you or would prefer another clinician.

The Medical Council is also clear in setting out that doctors must not prescribe controlled substances to those with whom they have a close personal relationship, except in emergencies. In practise, this means a doctor must not prescribe them unless there is no alternative prescriber – for example the patient’s usual doctor, the out of hours services and the emergency department - and immediate emergency treatment is necessary to avoid serious deterioration in health or serious harm.

In this rare circumstance, you should ensure you follow the relevant Medical Council guidance and that you can justify that your actions were in the patient’s best interests. It is important to distinguish that convenience and best interests, are not the same thing, though patients can sometimes confuse the two.

Any treatment of someone close to you involving medicines at risk of abuse, or those that affect their mental health, would be very difficult to justify. However, you should also remember that all medications carry risks, not just controlled drugs, such as unexpected drug interactions and inadequate communication with the patient’s doctor.

Doctors can be reported to the Medical Council for prescribing to someone they are close to. This would raise sufficient concern for the Medical Council to investigate further, with the potential for serious penalties.

Learning points:

• Medical Council advises that doctors should not treat, prescribe, or issue sick certificates or reports for people with whom they have a close personal relationship, except in emergencies.

• Providing good clinical care requires complete objectivity and be able to justify any decisions and actions.

• A personal relationship with a patient is likely to affect your judgement - a lack of objectivity can compromise patient care and pose a professional risk to you.

• If you do treat someone you know, your records must demonstrate you followed good practice and Medical Council guidance and that you can justify that any prescription or treatment provided was in the patient’s best interests.

• Treating someone close to you involving medicines at risk of abuse, or where medicines could affect the patient’s mental health, would be extremely difficult to justify before the Medical Council.

• If in doubt, contact your medical defence organisation for advice.