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.
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.
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.