Dr Gabrielle Pendlebury, Medicolegal Consultant at Medical Protection, looks at this increasingly common dilemma
In addition to encouraging the friend, family or colleague to contact their own GP where they will be able to arrange an appointment, a good starting point if you are asked to help is the GMC guidance Good Medical Practice, which states: “Wherever possible avoid providing medical care to yourself or anyone with whom you have a close personal relationship.”[i]
A collaborative, problem solving approach to helping them access the appropriate care would be of greater utility and more beneficial to your friend or relative, endowing skills that allow them to access and direct their care without being reliant on you.
Prescribing
While the law still allows doctors to prescribe for themselves and those close to them, since 2006 GMC guidance has warned against it.
We are all fully aware of the dangers of self-medicating or prescribing controlled drugs to family, friends and colleagues, and mindful of the risk of addiction and misuse. Any treatment of those close to you involving medicines at risk of abuse, or where medicines have an effect on the patient’s mental health, would be difficult to justify before the GMC, which advises not to prescribe controlled drugs for yourself or those close to you except in very limited circumstances.
However, there are dangers with all medications, such as unexpected drug interactions through incomplete or absent record-keeping and inadequate communication with the regular GP.
It is accepted by most clinicians that their judgement would be clouded when trying to self-diagnose and self-treat, realising that the wish to fulfil one’s duties could lead to a neglect of one’s own wellbeing, it is therefore advised that when in that position a suitably qualified colleague must be consulted.
Judgement may be affected in the same way when considering family members, friends or colleagues. An emotional attachment is bound to affect your judgement or focus.
This does not mean that you cannot provide an acute prescription when all other routes are unavailable. However, you should ensure that you follow the guidance[ii], are ready to justify your decision if challenged, and can show that your actions were in the patient’s best interests. Convenience and best interests are not the same, but patients can often confuse the two.
Each year a significant number of doctors are reported to the GMC for prescribing to someone they know – pharmacists are vigilant in this regard and will copy to the regulator any prescription about which they have concerns. The simpler cases can be resolved by providing a clear explanation, evidence that the action was reasonable and confirmation that the doctor knows and understands their professional duty.
GMC guidance states that if you do prescribe for someone close to you – which would include a member of staff – you must tell their GP (and others treating the patient, where relevant) what you have prescribed and any other information necessary for continuing care. You must have also the patient’s consent to share that information.
The same guidance extends to all aspects of medical care and not just prescribing. One should be particularly wary of treatment that falls outside of normal practice. It is also sensible not to fall into the trap of trying to help when no one else will, unless your actions can be clinically justified, and no other routes are available.
Defining a ‘close’ relationship can sometimes be difficult and you may well have to treat someone you know at some point in your career. But it should not be too difficult to differentiate between someone you know and someone with whom you have a close personal relationship.
If you have referred a patient who is too close to you, or it could be alleged that you are too close and this might compromise their care, it is best to point this out (to management or colleagues as appropriate) and if possible, have an impartial colleague involved. If there is no alternative, ensure that you keep detailed records and do not take shortcuts in the patient’s management. Your records must demonstrate that you have acted in accordance with good practice and justify any investigation or treatment plans you have put in place.
If you have any concerns around this issue, contact Medical Protection for advice.
Case scenario
A GP’s neighbour requests urgent advice from because his daughter has had an attack of cystitis, including traces of blood in her urine and she was unable to concentrate because of the pain. The patient revealed she had had cystitis before so the GP advised her to drink plenty of water, take some painkillers and suggested she might also need a course of antibiotics to clear up the infection. The patient persuaded the GP to prescribe the antibiotics and he agreed to prescribe amoxicillin. The GP did not have access to the patient’s notes.
Unfortunately, the patient developed a rash and it was discovered she was allergic to penicillin. The patient was embarrassed at not remembering she could not take penicillin.
In this instance the patient did not make a complaint and she recovered quickly from the rash but it demonstrates how issues can arise, that could lead to regulatory involvement or a claim if harm were to occur.