MANAGEMENT

THE PERILS OF TREATING FRIENDS AND FAMILY

THE MEDICAL BOARD OF AUSTRALIA HAS UPDATED ITS GUIDANCE ABOUT TREATING PEOPLE WHOM A PRACTITIONER IS IN A PERSONAL RELATIONSHIP WITH. AVANT’S JAMESON ABADAM AND DR USHMA NARSAI DETAIL THE RISKS INVOLVED.

JAMESON ABADAM

USHMA NARSAI As a practitioner, a family member or a close friend may ask for your medical opinion or a prescription. Sometimes it is difficult to refuse. However, writing that one-off prescription or referral may do more harm than good.

To demonstrate this, let’s use the case of Patient P who started to develop severe debilitating headaches. Dr S was a general practitioner and was in a de facto relationship with Patient P.

Dr S became his primary medical provider. She prescribed medication, wrote referrals and accompanied Patient P to appointments. During this period, two ophthalmologists raised their concerns with Dr S in relation to her being P’s treating practitioner and partner.

Dr S’s treatment of P led to an appearance before the Tribunal and a finding that Dr S’s knowledge, skill and judgement was significantly below the standard reasonably expected of a medical practitioner. The Tribunal also found that Dr S’s conduct constituted professional misconduct.

TREATING PERSONAL CONTACTS The Medical Board of Australia’s (MBA) new Code of Conduct came into effect on 1 October 2020 and has revised guidance about treating anyone who the doctor is in a close personal relationship with.

The Code states “whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate”. It now also states that doctors must not prescribe certain medication and perform elective surgery for anyone with whom they have a close personal relationship.

The code recognises that it may sometimes be unavoidable to provide care, such as in an emergency.

LACK OF OBJECTIVITY You may find it difficult to maintain your professional objectivity when treating family, friends and staff or colleagues. The problem is that there is an inherent conflict of interest between a therapeutic relationship and your personal relationship.

As practitioners, your treatment plan usually involves taking a complete history from and conducting a full physical examination of the patient. If you have a personal relationship with the patient, both parties may find this uncomfortable especially when asking sensitive questions or conducting a physical examination. In addition, the nature of your relationship and what you know of the patient outside of the consultation may influence both what you ask/do and what the patient tells you.

There is also a potential risk of missing vital information, which may impact on the overall management of the patient. This could include failing to arrange the appropriate investigations or referrals. It could also lead to a diagnosis being overlooked or delayed.

DISCONTINUITY OF CARE Ensuring continuity of care is the cornerstone of holistic patient management.

Unfortunately, it may be affected where practitioners have not kept appropriate records in cases where there has been an informal discussion, a one-off prescription or a referral has been written. This means that other practitioners may not have the complete picture, which could compromise patient care.

In the above case, Dr S failed to maintain adequate records regarding consultations with P. Furthermore, she arranged referrals to seven different specialists, all of whom did not have accurate and sufficient information to enable them to conduct a comprehensive assessment.

So, what to do if you’re providing care to family, friends or staff?

The MBA does recognise that there may be situations where practitioners may need to treat someone close to them, for example in emergency situations. If it is unavoidable to provide care, you should consider: • Setting boundaries and expectations with the patient about your care.

Personal relationships with patients can cause discomfort when discussing sensitive issues.

• Documenting your consultation and any treatment accurately. • Arranging and following up appropriate investigations. • Keeping all treating practitioners informed with the treatment provided; and • Handing over care to their usual practitioner as soon as practicable.

For doctors, it is in your nature to want to care for people. However, in the case of family, friend, staff or colleagues, it is best to let someone else care for them. While it might be especially difficult to not treat those close, it is in the patient’s best interests and your own.

More information can be found via the Medical Board of Australia’s Good medical practice: a code of conduct for doctors in Australia (from 1 October 2020). n

JAMESON ABADAM is a Senior Claims Manager at Avant. He also provides advice and support to doctors, medical practices and other health professionals through Avant’s Medico-legal Advisory Service.

DR USHMA NARSAI is a Senior Medical Adviser and Claims Manager at Avant and a general practitioner.