GP dilemma: A patient from overseas expects me to prescribe antibiotics

A temporary patient visiting her family from overseas came to see me to request antibiotics for a cold. When I refused to do so, she threatened to make a complaint about me to the GMC. These types of request for inappropriate antibiotics are a frequent problem for me and my colleagues, how should we respond?

Dr Marika Davies, senior medicolegal adviser, at Medical Protection advises:
GPs frequently deal with scenarios such as this. In a Medical Protection survey of over 500 GPs in England, 76% said that patients from other countries with different practices may have higher expectations of receiving antibiotic prescriptions.

A patient’s idea about treatment options and the consultation process will be influenced by what they have been used to. When considering a request such as this you should apply the usual principles of good medical practice in prescribing, as set out by the GMC, and take into account the cultural differences that may require additional management of expectations.

Patients cannot demand a particular treatment. Guidance set out by the GMC says that you are not obliged to provide treatment if you do not consider it to be of overall benefit of the patient, even if asked by the patient to do so. The GMC is also clear that you must prescribe drugs only when you are satisfied that they serve the patient’s needs, and that you must provide effective treatment based on the best available evidence.

It may be helpful to explore the patient’s concerns, and explain why the prescribing of antibiotics might not be in their best interests. If you decide not to prescribe you should explain your reasoning to the patient, who will understandably be concerned that they will not have the medication they feel they need. If required, you could also give them the opportunity to seek a second opinion.

Communication is key

Good communication is key in avoiding a complaint. You should be open and honest with the patient, and offer your complaints process should they remain dissatisfied. Even with the most open and clear explanation, however, some patients will remain angry. It is difficult not to take this personally but if you are able to step back, it often becomes clear that the anger is not actually directed at you. It may sometimes seem easier to just accede to a patient’s request and remove yourself from the firing line.  But this is unlikely to be useful in the long-run, if you are called upon to justify your actions.

The GMC expects you to be prepared to explain and justify your decision when prescribing medicines. Document the reasons for your decision carefully, as well as details of the discussion you have with your patient. This will be helpful should they decide to pursue a formal complaint. If you receive a complaint, contact your medical defence organisation for advice.

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