While the following is a personal account of a UK doctor, in New Zealand Medical Protection has assisted a number of members with notifications to their regulatory body about their provision of care to themselves or those close to them. Doctors should familiarise themselves with the Medical Council of New Zealand’s statement1. Similar guidelines exist for nurses2, physiotherapists3 and other health practitioners.
Doctors trying to help can find themselves falling foul of their professional obligations. Dr A found herself facing a regulatory inquiry for prescribing for a friend. Here she shares her experience with Dr Jo Galvin, Medicolegal Consultant at Medical Protection
It all started with an email from the GMC4
asking to confirm my personal information. I didn't think much about it and replied to it after several days. Then the worst happened – emails and letters came through – I was under investigation from the GMC for concerns relating to its guidance Good Medical Practice. I was confused – everything at the hospital was going well; I had nothing but good feedback from patients and colleagues. And then more information came through. This was not about the hospital work. This was about private prescriptions that I had written for a friend a while back.
Some six months earlier my friend asked if I could help obtain some medication for her elderly vulnerable parent. We come from a European country that should have a good medical system but in reality there are many shortcomings, so we are always anxious about our parents’ and family’s care back home. As a result, the request didn't surprise me. The parent had not taken this medication before, but he might come to require it. My friend was worried her father would not be able to obtain it back home. So here I was, on my first day off work, writing a private prescription for a non-UK patient, a family friend. All that I thought of was that I was helping a friend in need.
Arriving at the pharmacy, things changed. The pharmacist to whom I presented the prescription was concerned. She understood that neither she nor I had access to this person’s medical records and that could lead to unwanted complications. She refused to dispense the prescription so I left, somewhat bewildered that a medication that was not a controlled drug could be so problematic.
Then I started thinking about my friend, about her anxiety regarding her parent, and decided to try again until I managed to send my friend sufficient medication for her parent. Once that was done and dusted I didn't think about it anymore.
Then the GMC emails and letter came through and here I was trying to recall what had happened and why. I contacted Medical Protection and my department clinical director, and made a full disclosure of events. But while speaking to people about the events and at the same time reading the GMC guidance, it became apparent to me just how serious this was and what severe consequences could follow from an action that I initially thought quite trivial. On looking at things from a different angle I recognised this was a breach of my professional obligations. I accepted my mistake and tried to learn from it.
It was a steep learning curve. It was particularly difficult to let go of my “but I was just trying to help a friend in need” attitude and dissect things in a more clinical and less emotional way. The GMC guidance is clear and there is a lot of useful information out there. I was wrong, I've done something wrong and now a sanction was just around the corner.
Thankfully, my NHS Trust supported me fully through this process and the GMC concluded the case without further action. However, upon receipt of the GMC letter on the closure of the case I felt very unsettled. It wasn't clear to me that the GMC had the whole picture of what had happened. I felt more anxious after the closure of the case than I had felt while waiting to hear how I would be sanctioned for my breach of GMC guidance.
My medicolegal adviser at Medical Protection and my barrister wrote a letter on my behalf to the GMC and sent the full details of what happened to the GMC, together with my reflection on events. I felt much better knowing the GMC was now in possession of all the facts. I was expecting them to reopen it and investigate it further but I still slept better.
The final decision came through much sooner than expected. Being honest and candid paid off and the case was definitively closed without further action.
But no sanction doesn't mean no change. For me this has been an eye-opening string of events. It showed me how in one step I could go from being considered a trustworthy and valuable person and doctor to potentially untrustworthy. It showed me how trying to help could potentially cause harm to people close to me. I hope by writing this article, other doctors will avoid this pitfall, and think twice before prescribing for those close to them.
The GMC guidance on prescribing is “wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship”.
If I could give one piece of advice to every practitioner with a right to prescribe out there it would be: just know the GMC guidance and don't breach it. It is there for the purpose of protecting both the patients and you. It gains its full meaning in uncommon circumstances where we are pressured by the desire to help and fail to see the real risks we take. Be open, honest and respectful in relation to all your colleagues and patients. Be candid and honest with the GMC. Face up to your mistakes. It will give you peace of mind. And peace of mind has no price.
2Guidelines Prof Boundaries Booklet full.pdf
3Treatment of whānau, family members and others close to you standard – Physiotherapy Board (physioboard.org.nz)
For those outside the UK, the GMC is the General Medical Council