Medico-legal - Five patients you should not treat

MDU medico-legal adviser Dr Edward Farnan warns about the five types of patient you should usually redirect towards their own GP.

What should you do if a guest at a party starts asking you about their medical condition?
What should you do if a guest at a party starts asking you about their medical condition?

In general, impromptu 'corridor' consultations are best avoided. For specific advice, you should contact your medical defence organisation, but these five examples are all patients you should not treat.

1. An employee

Treating members of staff, or anyone with whom you have a close personal relationship, is tricky because it is difficult to maintain your clinical objectivity.

For example, if an employee has taken sick leave, might it be tempting to provide treatment you would not usually provide, to help them return to work?

Employees may also find it more difficult to talk openly with someone they see every day in a professional capacity, not least because of concerns about confidentiality.

There is in this case a potential for conflict within the practice, if concerns are raised about an employee's performance, especially where there are health implications.

It is difficult to approach employment matters objectively if a GP is aware of relevant information learnt in a private consultation. Any breach of the employee's confidentiality could prompt a complaint to the GMC or an employment tribunal.

2. A GP partner

The GMC expects all doctors to be registered with a GP outside their family where possible. It also counsels those who have health concerns to consult a suitably qualified colleague.

It adds: 'You must follow their advice about any changes to your practice they consider necessary. You must not rely on your own assessment of the risk to patients.'

Agreeing to treat a close colleague could place you in a difficult position if you discover something that poses a risk to your other patients. Could you objectively balance your duty of confidentiality to someone you know well, against the need to disclose information to protect others?

3. A relative needing medicine

It might be tempting to help when a family member urgently needs medication, but this is generally frowned on by the GMC.

This is not only because of the difficulty in maintaining objectivity, but also because you do not have access to their medical notes.

This will limit your ability to prescribe safely - without a record of contraindicated medication or allergies, for example.

In the case of controlled drugs, the GMC says they must not be prescribed to those with whom the doctor has a close relationship except in exceptional circumstances, such as where it is necessary to save life or alleviate uncontrollable pain or distress.

The GMC expects doctors who do prescribe for someone close to them to make a clear record justifying why there was no alternative, and to inform the person's GP about which medicines have been prescribed, unless the person objects.

4. A stranger at a party

This is a familiar scenario. You are at a party when a guest discovers your profession and approaches with a hopeful expression, to ask you about their medical condition.

As a rule, it is inappropriate to assume a duty of care for someone not registered with your practice. The exceptions might be temporary patients and Good Samaritan acts.

The party guest might push you for an examination, a diagnosis or even treatment. The logistics of carrying out an examination in a social setting and without access to the person's medical records are just too difficult.

The presence of other guests and background noise will make confidentiality and effective communication all but impossible.

There is a risk the person may feel reassured by what you tell them and put off visiting their GP, with potentially serious consequences.

5. Online consultation

Online services are a rapidly developing area, but it would be a mistake to agree to an online consultation with a patient unless you are satisfied you can do this safely.

Bear in mind the difficulties of communicating effectively when you cannot pick up on the patient's body language and tone of voice, you cannot physically examine them and you will be reliant on their recall when it comes to obtaining a full medical history.

The GMC's latest prescribing guidance includes a section on remote prescribing.1 It recognises this may be appropriate for some drugs and for some patients, but stresses it should only be done if you have 'adequate knowledge of the patient's health and are satisfied (the medicines) serve the patient's needs'.

If you are not satisfied you have enough information, perhaps because the person is not your patient, ask for their consent to contact their GP. If they object, the GMC says 'you should explain you cannot prescribe for them and what their options are'.

  • Dr Farnan is a medico-legal adviser for the MDU

Reference

1. GMC. Good practice in prescribing and managing medicines and devices (2013).

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