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A GP may have to treat friends and relatives when there is no alternative, but this should be avoided

if possible, says

Dr Yvonne McCombie

The Medical Defence Union recently took a call from a GP who had just joined a remote and deeply rural practice.

The GP was concerned to learn she would be providing care for colleagues and their families. This was because the practice covered a very large area and there were no other practices in the immediate vicinity.

It was planned that this GP's family would register with one of the other GPs in the practice. But she realised that in an emergency, if no other GP was available, she might have to treat her own family as well.

The doctor was aware of the GMC's advice that it was good practice for a GP and their family to be registered with a GP outside the family and the MDU's advice that it was best to avoid routinely treating friends, colleagues or relatives.

Make patients aware of pitfalls

In reply to her query, the MDU adviser pointed out that in remote areas where there is only one GP surgery it may be that there is no alternative than to treat friends, relatives and staff.

The GP in this case was advised to make sure her patients were aware of potential pitfalls, including the difficulties that could arise in remaining objective and the potential for problems with confidentiality.

She was told that the difficulty of remaining objective could be avoided in various ways – for example by seeking a second opinion from a colleague where necessary.

She was also told that while confidentiality is an issue that staff in any practice should be aware of, it is particularly important in close-knit rural communities. In many practices all staff, including the cleaners, have a confidentiality clause written into their contracts.

It goes without saying that it is important to train staff in the need for confidentiality.

All practices should make patients aware that personal information about them may be shared with members of the health care team. Patients should be told the reasons for this. Patients should also understand what will be disclosed if the GP needs to share identifiable information with anyone employed by another organisation or agency that is contributing to their care.

Most patients understand and accept that the sharing of information is part of good patient care. However, if a patient objects to particular information being shared with others providing care, this objection must be respected, except in certain circumstances, for example, where this might put other individuals at risk of death or serious harm.

Prescribing to family

MDU GP members occasionally ask about the question of prescribing for themselves or their family.

There is no legal reason why GPs cannot prescribe for friends, family or themselves. But given the ethical considerations about objectivity outlined by the GMC (see box far left), this practice is generally regarded as unsatisfactory. It may lead to problems in the long-term.

A patient's own GP would usually provide any necessary treatment and it is in a patient's best interest for the patient's own GP to be fully informed about, and responsible for, maintaining continuity of a patient's care.

In particular, doctors should avoid prescribing controlled drugs to themselves or their family. In rare cases, this has led to charges of misconduct by the GMC.

In their FAQs on prescribing (www.the-gmc.org.uk) the GMC advises a doctor who is not the patient's GP and who treats a patient without a GP referral to explain to the person the importance of keeping their GP up to date with their treatment and to inform the GP before beginning treatment, unless the patient objects.

If the patient doesn't want their GP to be informed, or has no GP, the GMC says the treating doctor must take steps to ensure the patient is not suffering from any medical condition or receiving any other treatment that would make the prescription of any medicines unsuitable or dangerous. And they should take responsibility for providing all necessary aftercare for the patient.

In rare situations, GPs may be unable to avoid treating friends and family, but as a general principle, avoiding treating yourself or your family, except in an emergency, as the GMC says, is 'common-sense as well as good medical practice'.

Yvonne McCombie is an MDU medicolegal adviser

GMC's advice on objectivity

The GMC's specific advice on this issue is entitled 'Doctors should not treat themselves or their families'

www.the-gmc.org.uk

It states:

'It is good practice for doctors and their families to be registered with a general practitioner outside the family, who takes responsibility for their health care.

This gives the doctor and family members ready access to objective advice and avoids the conflicts of interest that can arise when doctors treat themselves or those close to them.

It is hard to lay down an absolute rule: it makes sense for a doctor to treat minor ailments, or take emergency action where necessary. But doctors should avoid treating themselves or close family members wherever possible. This is a matter of common-sense as well as good medical practice.'

Dilemma over a daughter

A GP's daughter had recently moved away to university and had not yet registered with a new practice. In the meantime, the GP had issued two prescriptions for her asthma medication to 'keep her going'.

When the daughter asked for a third prescription because she hadn't yet got round to registering with the university practice but was planning to do so in 'a couple of weeks', the GP rang the MDU to ask whether he should continue to issue prescriptions.

The GP was advised that the GMC states that it is best to avoid treating your friends and family if possible because there may be a problem of lack of objectivity. It was also in his daughter's interests to have her condition properly monitored and the GP might feel that it would be difficult to do this remotely and would be better done face to face by her own GP or practice team.

The MDU adviser also suggested the GP read the GMC's prescribing advice on its website, particularly

the section about doctors' responsibilities if the patient

has no GP.

The cases mentioned are fictitious, but based on cases from MDU files – doctors with specific concerns are advised to contact their medical defence organisation for advice

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