Caution over self-prescribing

MANY clinicians hold the view that the ability to prescribe drugs for themselves, friends or family is a convenient aspect of the job. They argue it can often save time, and perhaps even NHS resources, to make a quick self-diagnosis and write up a prescription without the need to take time away from work to consult an independent GP or dentist.

But while this practice is not technically illegal, it does raise serious ethical concerns and could ultimately result in a complaint to the General Medical Council or General Dental Council. In their guidance on responsible prescribing, both professional regulators advise against treating and diagnosing yourself or those close to you.

MDDUS has handled a number of cases where practitioners have been subject to fitness to practise proceedings for either self-prescribing or for prescribing to a family member or friend. Some more serious cases have also been referred to investigators over allegations of defrauding the NHS in relation to prescription charges. In one case, a doctor faced fitness to practise proceedings before the GMC after it was found he wrote out prescriptions in his patient’s names for drugs that were for his own personal use.

"Other than in emergencies," the GDC says, "you should not prescribe drugs for yourself or for anyone with whom you have a close personal or emotional relationship."

This advice is echoed by the GMC in Good Practice in Prescribing Medicines which emphasises the importance of objectivity in providing good care, saying: "independent medical care should be sought whenever you or someone with whom you have a close personal relationship requires prescription medicines." It advises doctors not to prescribe a controlled drug for themselves or anyone close to them except in emergency circumstances where a delay "would put the patient’s life or health at risk".

There are many reasons for such tight controls on self-prescribing and prescribing to family/friends, most of which are connected to the loss of objectivity. In Responsible Prescribing, the GDC cautions: "Everyone needs objective clinical advice and treatment. Dentists who prescribe drugs for themselves or those close to them may not be able to remain objective and risk overlooking serious problems, encouraging or tolerating addiction, or interfering with care or treatment provided by other healthcare professionals."

Causing or fuelling addiction is a major factor in self prescribing, as the GMC warns: "Controlled drugs can present particular problems, occasionally resulting in a loss of objectivity, leading to drug misuse and misconduct." The guidance adds that doctors who do prescribe these drugs "must be able to justify your actions and must record your relationship and the emergency circumstances that necessitated your prescribing a controlled drug for yourself or someone close to you."

A loss of objectivity leaves clinicians unable to provide optimal care which can result in serious problems being overlooked, missed/delayed diagnosis or misdiagnosis.

While most clinicians should recognise that prescribing opiates or powerful painkillers is entirely unacceptable, it appears many still believe it is acceptable to diagnose and treat themselves or loved-ones for low-level illnesses such as chest infections or acne.

But MDDUS would advise clinicians to proceed with extreme caution when considering prescribing any medication for themselves or someone close to them and it is best to only do so in situations where urgent care is required and there are no immediate alternatives. In these cases, take comprehensive clinical notes including the treatment provided, any medication prescribed and your relationship with the patient.

Bear in mind that the GMC and GDC take a very strict approach to clinicians who prescribe for themselves or those close to them. Recent GMC fitness to practise proceedings have been raised against doctors for prescribing themselves or loved-ones with drugs such as benzodiazepines and opiates as well as with antibiotics and non-benzodiazepine hypnotics.

ACTION Prescribing for yourself or for someone close to you should be avoided except in situations requiring urgent care where there is no immediate alternative.

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