1. A colleague asks you to keep quiet about his problem drinking
Offering sympathy and support is one thing, but your personal and professional loyalties should not override your duty to raise concerns about a colleague who presents a risk to patients.
You could find yourself the subject of a fitness to practise investigation if a patient were harmed and it was discovered that you knew there was a problem.
If you cannot persuade your colleague to seek professional help, report your concerns using the established practice procedure.
If you are not satisfied the problem has been addressed, consider taking the matter to the GMC. You can seek advice from your medical defence organisation and the Practitioner Health Programme.
2. A 12-year-old patient says she is having sex with her older boyfriend but asks you not to tell anyone
While confidentiality is essential to maintaining a patient's trust, the GMC says doctors should usually share information about sexual activity involving children under 13 years old, who are considered in law to be unable to consent.
Child protection is the responsibility of every healthcare professional and there is a risk the patient is a victim of abuse, which outweighs her right to confidentiality.
You should explain to the patient that you need to disclose this information to the local children's services team because you are worried about her safety. Keep a record of your decision and reasoning.
3. A patient presents you with an extravagant gift
It may be better to decline politely if you believe the gift is overgenerous or the patient's intentions are more complicated than a straightforward expression of gratitude.
The GMC says doctors must not accept a gift if it 'may affect or be seen to affect the way you prescribe for, treat or refer patients or commission services for patients' (Good Medical Practice, 2013, paragraph 80). Your practice should have a policy on gifts.
4. A patient asks you to go out on a date
The GMC says you must not pursue a sexual or improper emotional relationship with a current patient. Maintaining boundaries is essential because a romance might compromise your ability to consider the patient's clinical interests objectively.
Personal relationships with former patients may also be inappropriate and the GMC has published guidance on factors that should be carefully considered before pursuing such a relationship (Maintaining a professional boundary between you and your patient, GMC, 2013).
5. A teacher asks you to confirm that a pupil attended an appointment during school hours
You should not disclose information about a patient to a third party without the patient's consent (or authorisation from someone with parental responsibility if the patient lacks capacity). It is unlikely that consent would be withheld in these circumstances, but you need to check before providing any information to the school.
6. A journalist writing a critical story about you asks you to comment
Patients can make detailed allegations in the press, but your duty of confidentiality means you cannot give your side of the story. It is usually better to explain that your duty of confidentiality prevents you from commenting, even off the record.
7. A patient who has a cold asks for antibiotics
GPs should prescribe treatment that is appropriate and in the patient's best interest. Do not be persuaded to prescribe treatment against your clinical judgment and the available evidence-based guidance.
8. A patient applying for life insurance asks you to omit details of their depression from your report
You have an ethical duty to ensure your report is not false or misleading and you must not deliberately leave out relevant information.
If the patient refuses to consent to you disclosing this information, you cannot complete the report, but it is advisable to explain to the patient that the insurer could draw its own conclusions from this.
9. A friend who is visiting from another part of the country has forgotten her contraceptive pills and asks you to write a prescription
Treating friends or family should be avoided wherever possible, although one exception might be an emergency where nobody else is available. In this situation, it would probably be better for your friend to register as a temporary patient with your local practice.
10. A nurse asks if a patient can be removed from the list after he fails to attend for the third time in two months
Patients should only be removed in exceptional circumstances, for example, if they have been abusive.
In taking such a step you need to act in line with your contractual obligations, which generally require you to have given the patient a warning in the preceding 12 months.
In addition, the GMC advises doctors to do what they can to restore the professional relationship and to explore alternatives to ending the relationship. Doctors must ensure that they act fairly and do not discriminate against patients (Ending your professional relationship with a patient, GMC, 2013).
- If you have any concerns about the medico-legal implications of saying no, contact your medical defence organisation.
- Dr Lucas is a medico-legal adviser at the Medical Defence Union.