Doctors should not treat or prescribe for themselves under any circumstance. Dr Ian Lavelle, GP and Medicolegal Consultant at Medical Protection, discusses this issue in the context of Medical Council guidance.
While the very nature of self-prescribing might suggest that a doctor treating themselves may be unlikely to come to the attention of the Medical Council, in fact the very opposite is true. The scrutiny of our regulator may reasonably arise following a pharmacy complaint, for example, or following a Pharmaceutical Society of Ireland (PSI) investigation of a pharmacy’s practices.
Of note, there is a Memorandum of Understanding between the Pharmaceutical Society of Ireland and the Medical Council, whereby one can report concerns to the other to investigate in the interests of public safety. A quote from same is as follows:
“Both parties agree to make complaints, where necessary or as and when required, to one another regarding breaches of the Pharmacy Act 2007 and the Medical Practitioners Act 2007, made by registered medical practitioners, registered pharmacists and/or registered retail pharmacy businesses (pharmacy owners) in the interest of patient safety and public protection."
In these types of cases, the PSI themselves will often become the complainant to the Medical Council. Medical Protection is also aware of cases where a pharmacist has raised concerns with the Medical Council about a doctor’s self-prescribing. Most commonly this occurs with the prescription of controlled drugs, benzodiazepines and antidepressant medication. The Medical Council provides ethical guidance1 in relation to self-prescribing and self-treating. This clearly states that doctors should not act as their own treating or prescribing doctor and outlines a doctor’s ethical responsibility as follows:
“58.1 You have an ethical responsibility to look after your own health and well-being. You should not treat or prescribe for yourself. You should have your own general practitioner, who is not a member of your family, and you should be vaccinated against common communicable diseases."
“58.2 If you have an illness which could be a risk to patients or which could seriously impair your judgement, you must consult an appropriately-qualified professional and follow their advice. This professional will have a dual role: to help and counsel you, and to make sure you do not pose a risk to patients and others. If such a risk exists, you must inform the Medical Council as soon as possible.”
In the event that self-prescribing by a doctor comes to the attention of the Medical Council, they will look at all the available facts in a particular case. Regardless of whether the Medical Council ultimately takes action or not, it still causes enormous stress for the doctor.
A recent survey2 of non-consultant hospital doctors identified widespread practice of self-prescribing, and also prescribing for family members and friends. In this survey, two thirds of respondents had self-prescribed. Of those who had self-prescribed, between 3% and 7% had prescribed a controlled drug or psychotropic medication. Some prevalent risk factors for self-prescribing were suggested, which included work-life imbalance and burnout, lack of support and intensely busy and under-resourced workplaces. In addition, doctors rarely take sickness absence from work for fear of increasing the workload of already strained colleagues. As a result, they may self-prescribe to hasten their recovery.
The Royal College of Physicians of Ireland provided the following comment in relation to the survey:
The RCPI believe doctors have a responsibility to themselves, their families, their patients and the healthcare system to take care of their own health. We advise doctors to monitor their physical and emotional well-being, and to seek assistance early if they have any concerns or feel they are experiencing significant stress . . . [W]e encourage doctors to provide support and assistance to colleagues in a confidential, sensitive and professional manner. This means reiterating the importance of the GP role, ensuring it is not bypassed and discouraging the casual or ‘corridor consultation.
The issue of self-prescribing and the survey study in question has also been the subject of a recent Irish Times article.3 It appears therefore that the issue of doctors self-prescribing, as well as the enormous pressure they are working under, is gaining national prominence.
Summary
Whether self-prescribing results from simple convenience, a lack of objectivity or denial, it may present risks to both the doctor’s health as well as that of their patients. All doctors should be aware that if they self-prescribe they are at risk of a complaint to the Medical Council and sanctions against them. The Medical Council’s ethical guidance is due to be updated in 2022, and it is possible that there may be further strengthening of their existing guidance.
References
1Medical Council, Guide to Professional Conduct and Ethics
2Physician, heal thyself: a cross-sectional survey of doctors’ personal prescribing habits, Yvonne Hartnett, Clive Drakeford, Lisa Dunne, Declan M McLoughlin, Noel Kennedy
3‘Doctors in Ireland are under enormous pressure’: Why medics self-medicate