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At the heart of general practice since 1960

GMC rules shackle GPs who want to care for their kids

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Like many doctors, I have a habit of underplaying the symptoms of serious illness amongst family members. We have all heard of stories of GPs’ kids being marched to school with a broken arm and surgeons’ passing off appendicitis as a bit of D&V. We may have experienced every symptom in the book as a medical student, but as professionals, we do not wish to portray the image of a neurotic parent.

So when my three-year-old baby was unwell recently with a high fever and cough, I practiced what I preach on a daily basis, which was to give her three-hourly alternating paracetamol and ibuprofen.

In fact, I did it with such due diligence that I must have gone through an entire bottle of each as she was being dosed like clockwork, day and night. My only ‘assessment’ of my daughter was to take her temperature every four hours and be mildly concerned that it was not coming down below 38 degrees.

After four days of this, I decided to remove the GMC fitness to practice shackles and actually assess her. To my horror, she had a rapid respiratory rate and all the signs of pneumonia. In fact, I think this was the first time I had actually listened for whispering pectoriloquy since being a medical student.

Thankfully, she is now on the mend with a good dose of antibiotics, but the whole experience made me reflect on why I was so hesitant to assess her properly. The main reason is the plethora of publications and guidelines coming from the BMA and GMC with the general theme of ‘do not heal thyself’. The GMC’s Good Medical Practice guidance advises that doctors ‘wherever possible … should avoid providing medical care to anyone with whom [they] have a close personal relationship’. Of course, this mainly refers to treatment and prescribing but it is sometimes hard to define the provision of medical care.

Twenty years ago we were all at it. I remember taking my own wound swab on a ward and then obtaining the required antibiotics from the hospital pharmacy – no questions asked. Many of my colleagues would be on industrial strengths of ranitidine to counteract the heavy drinking and long on-call stints.

It is interesting that at a time when we are encouraging patients to adopt greater self-care skills, we are disempowering doctors from assessing and managing their loved ones appropriately. We offer patients rescue antibiotics and steroids for their COPD, give them repeat prescriptions for their UTIs and thrush, encourage them to invest in thermometers, teach them how to take their own pulse when they suffer from palpitations and also teach parents how to identify the signs of respiratory distress in their children.

Yet, I was reluctant to use my knowledge, skills and experience or any of the tricks in my toolbox, because I was so mindful of the recent GMC fitness to practice guidance. I would like to think that those doctors facing disciplinary action were those who had self-prescribed controlled drugs, but I could not stop this hysteria over self-prescribing from affecting my ability to look after my child.

The bottom line is that we can’t erase what we are, and if we try it can lead to denial and negligence.

I am a mum, and I’m also a GP with a knowledge base and skills. To deliberately ignore my medical skills is a bit barmy and reflects the way we are becoming increasingly scrutinised as a profession. 

Dr Shaba Nabi is a GP trainer in Bristol.

Readers' comments (21)

  • A case such as this demonstrates quite clearly the GMCs descent into immorality based on dogma and control. Whilst I'm sure the bulk of doctors would accept that it is unwise to prescribe oneself benzodiazepines, controlled drugs or medication outside of your area of expertise; there is a fairly strong utilitarian argument that doctors are more than capable of self managing common illnesses without loosing their sense of proportion. This practice is the norm elsewhere in the western world. We all know the NHS is pretty far from perfect and that doctors face significant stigma in the face of illness, something the GMC is happy to reinforce. Across the UK you will find accountants who manage their own finance, builders who build their own houses and farmers that consume their own produce. Why should doctors be any different and be denied autonomy? Its not as if we suddenly loose all sense of perspective when we or a family member becomes ill, something we all must eventually face. Unfortunately the reality in todays chronically under-resourced and often shambollic NHS is that a doctor is far more likely to be motivated to provide excellent care to one of their own than an overstretched GP or hospital doctor. Sadly it is likely to take a number of deaths until this issue is taken seriously.

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  • Hi Shaba..sympathies. I am glad that your child is now well and safe. Your story resonates so much with me. I too had the experience of trying to treat my child, as my wife was away and so could not easily take her to the GP or hospital . I treated her for 2days as gastroenteritis before finally deicding it was a case of atypical appendicitis and took her to the hospital. Even the surgeons decided it was gastroenteritis before doinga laparascopy nearly a day later and finding... a retrocaecal appendix about to burst. I fully agree with you re the silliness of the GMC rules of not treating family and friends. Totally ridiculous. We are not children. It should avice us to be cautious and not ban it. I can understand it being against doctors self prescribing benzos etc. I hope the GMC will see sense and change its rules and be harsh on self prescribing controlled drugs etc and be lenient with others .

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  • Just to add....You write very eloquently and I love reading your posts. Keep blogging .

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  • The GMC did a consultation and ignored the views of those who do a valuable service to the country by reducing unnecessary A&E and GP visits by advising friends and family on simple medical matters.

    Personally having prevented multiple A&E visits for minor head injuries, ?fractures and non chest infections etc view having a GP n the family as not just a privilege but a huge valuable asset.

    I wish I had intervened in the past when I instead stood back and allowed renal specialists in a tertiary care centre give my father with renal failure long term NSAIDs leading to the inevitable perforation and preventable death.

    Even self prescribing should be permissible, though I fully accept controlled drugs and complex care should be under an independent practitioner.

    I like many others have no spare time to see my GP as we both work the same hours and getting an appointment in my GP is near impossible at a convenient time. My only option would be inappropriate out of hours use, and wasting my precious spare time.

    I will continue to interfere, and where reasonable advise and aid all strangers in my practice as well as those I care for and love with the same diligence, as the GMC is wrong in this matter.

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  • I would like to gently disagree.
    There is nothing whatsoever to stop a doctor examining a member of their family if they so choose, nor to stop a doctor making reasonable decisions about whether to seek help from another practitioner or not.
    Members of the public make these decisions all the time based on their own personal knowledge and previous experience. So do we.
    However, it is well recognised that it is impossible to make a completely objective assessment about someone close to you and the consequences of getting it wrong are dire. I personally could never live with the responsibility of damaging a member of my family and the emotional overlay is very strong. I tend to ignore things until I can be persuaded that they are serious, and then panic.
    If your child has a temperature for several days above 38 and you notice a raised respiratory rate seek help from another doctor who you trust. They will make a reasoned assessment about treatment and whether admission is required. You cannot.

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  • As a GP trying to get an appointment to see a GP is near impossible. I would have to take a day off work to get an urgent on the day appointment. Who would then see my 30+ patients on that day? We are too busy for patients let alone each other.

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  • "As a GP trying to get an appointment to see a GP is near impossible. I would have to take a day off work to get an urgent on the day appointment."

    Welcome to the real world - what do you think other patients have to do?

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  • I think the issue for GPs is that we have extended our working day from 8 - 8 to allow people in other jobs to get appointments. We can therefore not access any service provided by society during the week in order to be available for everyone else.

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  • "I think the issue for GPs is that we have extended our working day from 8 - 8 to allow people in other jobs to get appointments."

    Again welcome to the real world - lots of people work shifts and long hours. Working unpaid overtime is the norm for many people. Taking a day off to see the doctor is also a norm for many people. Losing income in order to visit a doctor is also the norm for many self-employed people.

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  • Dear Anonymous 10-35,
    some valid points however a non medic taking time off work does not undermine the availabilty of the very service they are trying to use in a spiralling out of control manner.
    The statistics on the adverse health outcomes, suicide rates for medical staff is horrendous compared to similar professional groups.

    http://bma.org.uk/practical-support-at-work/doctors-well-being/websites-for-doctors-in-difficulty

    is a useful resource.

    I would be grateful if the Trolls could remember that medical staff are human and likely to reciprocate callosity and intolerance when they are at breaking point.
    Which would be about now for most medical staff.

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