Prescribing to friends and family: an ethical minefield

Achyut Valluri is a senior trainee in Renal medicine in Scotland and in August 2015  finished a year as a Clinical Leadership Fellow with the GMC

I’m getting to the stage of life where I’m starting to talk about the way things used to be. As a house officer I remember hearing my seniors speak openly about prescribing themselves a course of antibiotics to keep that cough at bay. Antimicrobial stewardship aside, this is simply not accepted as a professional privilege anymore.

"Most doctors would accept that they’d struggle to remain objective when trying to self-diagnose and self-treat. Many might feel this even more when dealing with family."

“Most doctors would accept that they’d struggle to remain objective when trying to self-diagnose and self-treat. Many might feel this even more when dealing with family.”

Although the law still allows doctors to prescribe for themselves and those close to them, since 2006 the GMC’s guidance has clearly warned against it.

The dangers of self-medicating or prescribing controlled drugs to family, friends and colleagues are clear – the risk of addiction and misuse. But there are dangers even with less strong analgesics and antibiotics, like the chance of drug interactions through incomplete (or absent) record-keeping and inadequate communication with the regular GP. Most doctors would accept that they’d struggle to remain objective when trying to self-diagnose and self-treat. Many might feel this even more when dealing with family.

Having empathy is good as a doctor; having an emotional attachment is not – it’s bound to affect your judgement or focus. Being husband, dad and son is responsibility enough, without having to be the doctor too! And I know I’d never forgive myself if I missed an appendicitis that one time my daughter complained of a tummy ache.

But where I’ve heard the most debate is around “obvious” minor ailments. An opinion piece in the BMJ asked; if trust is at the heart of the doctor-patient relationship, does guidance that does not value or trust in doctors’ ability to judge the situation undermine confidence in the profession? Should a doctor not be trusted to be able to treat their own fungal nail infection rather than taking a morning or afternoon off – cancelling their own patients – to see their GP?

Many times it is hard to know at what point we’ve stepped over the line so my own approach would be to stay well clear of it. Others might prefer to rely more on their moral compass. It isn’t a straightforward area, hence the need for a regulator to police the guidance in both a flexible and sympathetic way.

Read the GMC’s guidance on doctors prescribing to themselves or those close to them. We have also published a helpful resource on prescribing to support doctors further on our website.

AValluriAchyut Valluri is a senior trainee in Renal medicine in Scotland and in August 2015  finished a year out of programme as a Clinical Leadership Fellow with the General Medical Council.

 

 

 

The Scottish Clinical Leadership Fellow scheme is run by NHS Education for Scotland in partnership with Scottish Government, the General Medical Council and the Scottish Academy of Medical Royal Colleges. Much like the National Medical Director’s Clinical Fellow scheme in England, the one year posts offer a unique opportunity for interested individuals to develop leadership and management capabilities, and contribute to aspects of contemporary health care and medical education development in an apprenticeship model.

8 responses to “Prescribing to friends and family: an ethical minefield

  1. A helpful reminder of this tricky situation. I know someone who was disciplined for prescribing cetraben for their kids when this was already on their repeat prescription. Someone else converted an NHS prescription into a private prescription to save a few pounds. It would be useful if the GMC could give some further examples as to when it may be appropriate to self prescribe to avoid unnecessary disciplinary action.

  2. It is an important skill as a doctor to learn to be able to assess ones own and ones friends’ ailments in an objective manner, and when to seek help. If you can do this, I think self caring including necessary prescriptions is acceptable. The situations where this occurs is increasing, due to the continuing deterioration of access to in- and out-of-hours NHS GP care. In fact, when you are in the situation of needing a prescription quickly for you or your family, it really makes it clear to you that the level of access for your patients in the NHS is below par.

  3. My experience is the exact opposite of the ‘Dr Sarah Browne’ anecdote in the GMC newsletter. My wife was admitted to hospital, and I read her armband which noted “Allergic to Keflex” (Cephalexin). My dear, non-medical wife knew it was an antibiotic with an X in it, and agreed with the helpful nurse’s suggestion. Thus increasing the risk she would receive Amoxil (Amoxycillin), to which she has a significant allergy.
    Never be afraid to use your objective medical skills to help your family as you would a stranger. Dr Valluri, what you never forgive yourself for, is if you diagnose your father’s skin cancer before he even notices it, then remain professionally disinterested after you advise him to see his GP who arranges treatment. My father died aged 59 of skin SCC and medical negligence, because doctors who didn’t know him made simple errors. An intern wrote ‘melanoma’ on a CT request form. A radiologist, with inadequate history, reported bone destruction consistent with invasive metastatic malignancy. An oncologist who couldn’t interpret a CT scan trusted the radiologist and instituted the wrong treatment. None of the three doctors recognised the CT change was a simple Caldwell-Luc biopsy incision, because they didn’t know or understand the history. My surgical oncologist brother and I got involved too late to save our father from multiple medical errors, made by reputable people.
    If you think your daughter has appendicitis, and the casualty doctor or GP disagrees, trust your own gut and insist on a GI surgeon’s opinion. Do not join the many parents who are sure their child is sick, but have been reassured and sent home by unrelated doctors, only to have their child die of peritonitis, meningococcal sepsis, ruptured spleen etc.
    As doctors, we are expected to treat murderers and rapists with professional courtesy, objectively utilising all our skills. Why should an ’emotional attachment’ be any more of a hindrance to a doctor than emotional revulsion?

    • Profound insight..
      This makes deeper sense than you would ever know..I have just learned a lot..
      Thanks
      Regards
      Edozie Ogbonna

  4. Mr Valluri states that most doctors would admit that they would struggle when it comes to self diagnosis or self treatment
    Is there any statistical evidence or it that his personal opinion?

    I dont agree with him and would not underestimate a broadly trained critically minded doctors clinical judgement.

    We probably all agree with Mr Valluri that there are problems involved in self prescribing controlled drugs or psychopharmaca but what is old fashioned or medically wrong in treating our own fungal nail infections or our sore throats ?

    I would like to see a debate initiated by the GMC about the risks and complications of delayed or insufficiantly treated infections within the current NHS settings.

    • Clicking links from this story led me to the MDU website. “Between January 2010 and 2015 the MDU was notified of 40 cases, where there was an allegation of a delay in diagnosing a child’s brain tumour.” These are of course the tip of the iceberg in that there may be more unrecognised cases. But clearly, these represent (presumably non medical) parents who had noticed something like subtle dyspraxia or dysphasia, or altered headache pattern, in their child. Why did the parents recognise what doctors did not? Perhaps prolonged personal observation, intimate knowledge, and loving concern can outperform detached professionalism.

      It would indeed be good science to see some figures in this contentious area. For example, some doctors treat their own children, no lawyer can. Is there a difference in crude mortality between children of doctors and of lawyers? A doctor may treat her own sore throat and soldier on, or attend her GP and be certified unfit for work for a few days. What is the net cost/benefit to the health system of either approach? Will she misdiagnose pneumonia while auscultating through blocked ears, or is there a greater risk her patient with pneumonia will deteriorate while waiting longer for an appointment? What is the risk of a doctor self-prescribing the wrong drug, compared with the risk of an unrelated doctor prescribing/administering the wrong drug; and given the higher direct and indirect cost of seeing a colleague, what is the number needed to treat to balance the cost/benefit to the health system?

      The MDU website headline today is: “Money is haemorrhaging out of the NHS in compensation claims.” At the very least, a responsible doctor should be assessing whether his management of his/ his relative’s condition is likely to be better than the average unrelated doctor.

  5. Common sense prevail all.That is all I can say.If you scared to prescribe either self medication or to your family then there is something wrong with the medical education you had.It is ludicrous for one to say that GMC will get you if you prescribe antibiotic and then your daughter or father had a interaction or something happen to them.If you are prescribing doesn’t matter father or mother or your daughter you should know their hx as well as what medication they are own just like your patient.If you practice medicine in fear of GMC or litigation constantly “you might as well go and sell newspaper on the street or lay bricks” because I can assure you you will not enjoy medicine.everything must be done with caution and carefully regardless it is your own or your patient.

  6. Pingback: Good practice in prescribing medicines | Docbeecee·

Leave a comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s