Practicing physicians often question whether it is appropriate for them to treat family, friends, or colleagues. It can be challenging when people with whom you have a close personal relationship seek informal, out-of-hours medical advice or request prescriptions.
It can be difficult to know how best to respond to, or refuse, such requests. In these situations, you should be aware of the potential risks associated with providing treatment and care to family, friends, and colleagues.
Guidelines
While guidelines differ around the world, the Medical Board of Australia states that medical practitioners should avoid providing medical care to anyone with whom they have a close personal relationship, including family, friends, and colleagues, except in the case of an emergency. This is because of the lack of professional objectivity, the possible discontinuity of care, and the risks to the doctor and the patient.
Other issues that may arise when treating people with whom you have a close personal relationship include a decreased quality in the standard of care you provide, improper prescription practices, incorrect documentation, and incorrect procedural practices.
Case Study
A recent case highlights some of the issues that can arise in relation to treating family members.
In this case, the Victorian Civil and Administrative Tribunal in Australia was asked to consider three allegations of professional misconduct concerning a doctor’s treatment and prescribing of scheduled drugs—including drugs of dependence—for his wife.
The doctor had prescribed schedule 4 medications to his wife between 2014 and 2019. His conduct became known as a result of a notification made by another health practitioner in mid-2019 when the doctor’s wife was admitted to hospital for an alleged overdose.
The Tribunal found that the doctor had been inappropriately prescribing the medications to his wife. This was based on the evidence submitted by the Medical Board regarding the extremely serious nature of the doctor’s conduct in prescribing his wife with numerous highly addictive medications. This occurred over a five-year period and placed his wife at risk of serious harm. The Medical Board noted that the doctor had prescribed the medication in excessive amounts or where not clinically indicated, failed to inform his wife’s GP of his concurrent treatment and prescribing, failed to refer his wife for assessment and treatment by other health practitioners, and failed to notify or consult with the Medicines and Poisons Regulation Branch of the Department of Health in relation to his wife’s drug dependency.
The Tribunal also found that the doctor’s conduct was in breach of various provisions of Good Medical Practice: Code of Conduct for Doctors in Australia, and the RACGP’s guide on “Prescribing Drugs of Dependence in General Practice, Part A,” which required that drugs of dependence should “be prescribed from only one practice and preferably by only one GP.”
The Tribunal noted that, other than one referral to a neurosurgeon, there were no consultation notes or medical records maintained by the doctor in relation to his wife. In the absence of any records, there was no evidence to substantiate or support any clinical justification for the prescribing of drugs of dependence to his wife. This was also in breach of the Code of Conduct, which requires the maintenance of “adequate records.” The Tribunal therefore found that the doctor had maintained inadequate clinical records for his wife between September 2014 and September 2019.
Although the doctor made early admissions, cooperated with investigators, retired from practice, and surrendered his registration, the Tribunal found that his actions amounted to professional misconduct, and he was reprimanded and disqualified for a period of 18 months.
As the Tribunal said, this case “should serve as a salutary reminder to the medical profession as to the inherent dangers of treating family members, absent emergency, more so where (as in this case) that treatment includes the prescribing of drugs of dependence.”
Recommendations
Although the above case is an extreme example of the types of issues that can arise from treating a family member, it is advisable for doctors to avoid providing medical care, including prescribing medication, to anyone with whom they have a close personal relationship, unless in the case of an emergency.
If you receive such a request from a family member, friend, or colleague, consider following these recommendations:
- Listen to their concerns and issues to show that you care—sometimes people just want to talk and are not actively seeking your medical advice.
If they do ask your opinion about a medical issue, politely but firmly advise them to see their usual doctor.
- Explain that many medical practice guidelines advise against providing treatment and care—including issuing prescriptions—to family, friends, and colleagues.
- Explain that it would not be appropriate for you to provide an opinion, treatment, and care as you are not their usual doctor.
If you have any queries or concerns about requests for providing treatment and care to family, friends, or colleagues, contact your MPL insurer for support and guidance.