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Dilemma: Self-prescribing

Your GP partner tells you that he has been suffering from low mood but that he is feeling better since he started prescribing sertraline for himself a month ago. You are concerned about the self-prescribing and lack of objective assessment and follow up, as well as fitness-to-practise issues. What do you do?

A positive is that the partner has confided in me

Dr Thomas Bloch - online

The GMC of course takes a dim view of self-prescribing doctors, and I suspect there isn’t a doctor in the country who hasn’t taken the odd course of antibiotics or non-steroidals. However, sychotropics take us into much trickier waters, and taking controlled drugs in this way is illegal.

What immediately strikes me as positive is that the partner has confided in me. I would be much more concerned if I had found out by accident. There may be various reasons why he has done so: it may simply be the wish to unburden himself of a guilty secret, no doubt knowing this is not right.

Perhaps his low mood is due to unhappiness surrounding work, and this is the way he has chosen to bring up the subject, or he may be seeking informal advice and support. He may be concerned about details of his depression (which on the face of it does not appear to be serious) becoming a part of his medical record with consequences for possible future medical insurance.

I would wish to lend a sympathetic ear and be supportive, but would need to make it clear that he should seek the counsel of his own medical practitioner, as this kind of scenario requires objectivity and a certain clinical detachment on the part of the doctor, and that a work colleague is not the correct person to be dealing with this.

As a partner one would face some possible conflicts of interest when, for example, advising on time off work, so it is best to separate medical advice from concern for a friend and colleague.

Dr Thomas Bloch is a GP in Broadway, Worcestershire

Your responsibility is to support him

Dr Dennis Cox

Your partner has been going through a bad time and it should be acknowledged that he has shown a lot of courage in disclosing this matter to you.

It is true that there may be objectivity and Fitness to Practice issues to address but, right now, your responsibility is to be there for him, to listen to him and to try to understand why things have been so dreadful.

It is highly likely that he has mentioned this to you because he needs someone to talk to and that through that dialogue, he will gain the necessary insight to realise that he needs to discuss this issue with his own GP.

If you don’t get to that point, then it is a judgment call – and you will need to take medicolegal advice on it.

Dr Dennis Cox is a GP in St Ives, Cambridgeshire and RCGP national commissioning champion

 

 

Follow the GMC’s expectations of yourself and your partner

Nick Clements online

 

This is a situation in which support to a colleague must follow the GMC’s expectations of yourself and your partner. Patient safety is the paramount consideration; serious or persistent failure to follow GMC guidance will put a doctor’s registration at risk.

The GMC states ‘if you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice…’ You should consider the extent of these concerns to establish how to meet these responsibilities.

Your partner should be made aware that the GMC expects doctors to be registered with a GP outside their family. GMC guidelines state ‘wherever possible you must avoid prescribing for yourself…’ and, if you do, ‘you must make a clear record… and tell your own GP what medicines you have prescribed, together with any other information necessary for continuing care’.

Continuing to self-prescribe anti-depressants without having the objective oversight of a GP would raise questions about his fitness to practice. In the event of an adverse incident, both you and your partner’s registration could be at risk.

Ideally your partner will be persuaded to cooperate with support from yourself and a trusted senior colleague, or the area team, and he may wish to take advice from his own MDO. Document your concerns, where and when you raised them and keep copies.  

Whilst suspension under the Performers Regulations or referral to the GMC is available as a last resort, it should usually be possible to ensure appropriate patient safety measures through less draconian measures.

Dr Nick Clements is head of medical services at the Medical Protection Society.

Readers' comments (2)

  • I am horrified that none of the above answers suggest alternative sources if support. We do not officially live in a dictatorship and it is not a legal ( or indeed GMC) requirement to discuss any matter with your registered GP.
    There is often more difficulty for a GP to discuss issues like this with an NHS colleague who is likely to be working in close proximity.
    I would suggest this option but, if the colleague was not comfortable with this, suggest he sees a private GP or psychiatrist or contact the BMA counselling service or sick doctors which is confidential.

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  • I am working abroad as a GP. Here self-prescribing is a non-issue. GPs are presumed to be able to make clinical decisions about their own health. If I want to prescribe something for myself it is noone else's business.
    The question of substance abuse, non-fitness to practise etc is dealt with as needed and is not linked to self-prescribing.
    It would be good to remember that 'Good practise' is not universal. You are forced to believe that self-prescribing is wrong. That is not the view in many countries.

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