IT’S not uncommon for clinicians to be asked to provide healthcare advice or treatment to a colleague. Some healthcare staff might even think of it as a potential job perk. Instead of taking time away from work to visit their own doctor or dentist they may decide it’s more convenient to approach you.
It might be tempting in the current lockdown to offer advice or prescribe a medicine to a colleague in order to save them having to go elsewhere for treatment and risk catching or transmitting the coronavirus. Your colleague might view this as doing the organisation a favour by not taking time off for an outside appointment.
Refusing to offer advice or treatment in this situation might feel awkward or overscrupulous. Doing so might seem particularly difficult if your organisation has a long-established culture where it’s been seen as acceptable to prescribe the odd antibiotic or pain killer to a member of staff when the risks appear minimal. However, the general rule is to advise your colleague to make an appointment with their own doctor or dentist.
No doubt we can develop close relationships with colleagues, working together in sometimes intense circumstances, day after day. Often we get to know a lot about their personal lives and problems. It is important to recognise that these close personal relationships can inhibit the ability of a doctor or dentist to make any potential clinical decision objectively.
The GMC is clear on the matter in its guidance Good Medical Practice, stating in paragraph 16g: "In providing clinical care you must... wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship". This is reiterated within the supplementary guidance Good practice in prescribing and managing medicines and devices*: "Wherever possible you must avoid prescribing for yourself or any one with whom you have a close personal relationship."
In a dental setting, the position differs in that there is no specific rule prohibiting a dentist from providing care to friends, family or colleagues generally and this may be described as accepted practice within the dental profession. There is, however, one clearly outlined exception to this general principle, as set out in the GDC’s supplementary Guidance on prescribing medicines:
“Part of prescribing medicines responsibly means prescribing only where you are able to form an objective view of your patient’s health and clinical needs. If you prescribe medicines for someone with whom you have a close personal relationship you may not be able to remain objective and you could overlook serious problems, encourage addiction, or interfere with treatment provided by other healthcare professionals. Other than in emergencies, you should not prescribe medicines for anyone with whom you have a close personal relationship.”
Access to clinical records
There are other, logistical reasons for avoiding the provision of treatment to colleagues. You may be approached for advice regarding a fairly straightforward issue such as UTI symptoms, or asked to perform a quick examination such as a BP check. However, in the absence of a full medical history you will be relying purely on your colleague to relay clinically relevant information and this will make it difficult to come to an informed shared decision on advice or potential treatment. There could be something in the medical records regarding the presenting complaint that your colleague thinks is not relevant or is inappropriate to disclose.
Any interaction with a patient – be it simple self-care advice or a prescription – should be noted in the patient records and this can be difficult without direct access. It is important not only for continuity of care but also has potential legal implications if evidence is required for defence in a claim or regulatory complaint.
Disputes over treatment
Dealing with complaints by patients regarding alleged inadequate advice or treatment is difficult enough, but when involving a colleague this can complicate matters further and impact relationships across the team.
One example of a complaint escalating into a staff dispute involved a dentist providing tooth whitening treatment to a member of staff at a discounted rate. The individual complained that the treatment both didn’t work and had caused increased sensitivity. A refund was offered to the staff member however they sought compensation after having to pay for their own dentist to carry out treatment for the tooth sensitivity. The dentist carrying out the initial treatment had to seek MDDUS advice and assistance on the matter and the conflict had an impact on team morale and trust.
Clear conflicts of interest can exist from an employment law perspective when clinicians wear two hats, one as a GP/GDP and the other as an employer. It is therefore preferable to avoid having staff members registered at the practice as patients. There are of course scenarios where providing treatment to a colleague is warranted. These include emergency situations where delay can have severe consequences on someone’s health. A quick risk assessment should be undertaken and any necessary treatment provided to stabilise the condition.
GMC guidance states that if you do prescribe for someone close to you (which would include a member of staff), you must tell the patient’s GP (and others treating the patient, where relevant) what you have prescribed and any other information necessary for continuing care. You must have the patient’s consent to share that information.
Practicing in a rural area can also limit options in finding alternative medical or dental care – so having staff as registered patients may be sometimes unavoidable. In such circumstances you must take care to ensure that decisions on clinical treatment are not influenced in any way by business priorities, such as being reluctant to sign your patient off unfit from work knowing this would mean the practice is down a member of staff. Alternatively, a doctor or dentist who is not a partner (and so not the employer of the practice staff) could lead on providing clinical care to practice staff.
- Advise colleagues to seek advice from their own doctor or dentist where possible and practicable.
- Carry out a quick clinical risk assessment in emergency situations and provide minimal treatment required to make the patient safe until further help can be sought from their own healthcare provider.
- Ensure unavoidable clinical decisions regarding staff are not influenced by any business needs or other conflicts of interest.
- Follow regulatory guidance on treating family and close associates, as well as guidance on maintaining adequate patient records.
Kay Louise Grant is a risk adviser at MDDUS
*The GMC has published an updated version of Good practice in prescribing and managing medicines and devices, which comes into effect on 5 April 2021. Read more.