The Tale of The Dog and Saying No

Case History

The pharmacist explained to the JMO that her dog had an infection and had been prescribed Augmentin Duo by the vet. Apparently the dog’s infection had not completely resolved, and the vet had recommended that the dog continue with another course of the same antibiotic. The pharmacist said she did not have a repeat prescription for the antibiotic and she asked the JMO if she would write a repeat prescription for the Augmentin Duo, so the medication could be continued without any gap.

The JMO felt reluctant to provide the prescription because it was for an animal, and beyond her experience or prescribing rights. However, she also felt she wanted to assist her colleague and she did not think that the pharmacist would ask her to do something which was “illegal or wrong”. She also felt it was a “low risk” situation, as it was a continuation of an antibiotic only which had been initially prescribed by a vet. The JMO therefore agreed to write the prescription, but said she would make it clear that the prescription was being written for the pharmacist’s dog.

A few months later, the JMO received a letter from the Director of Medical Services at the hospital. The letter stated the JMO was required to attend a disciplinary interview at the hospital with the Director of Medical Services. A copy of the hospital’s disciplinary procedure document was enclosed with the letter. The purpose of the interview was to discuss the allegation that the JMO had written a prescription on a hospital prescription form for veterinary use. The letter went on to state “you are not authorised to write prescriptions for veterinary use, and the hospital does not treat animals”.

Medico-legal Issues

On receipt of the letter, the JMO sought advice from MDA National’s Medico-legal Advisory Service. MDA National arranged for a Medico-legal Adviser to meet with the JMO and attend the interview at the hospital as a support person for the JMO.

The meeting between the Director of Medical Services and the JMO went very well. The JMO acknowledged it was essentially a “wake-up call” that she should more critically assess any unusual requests which were made of her. No formal warning was given and the Director of Medical Services confirmed that the meeting was the end of the process.

The JMO was very relieved and subsequently wrote to MDA National: “Again, my deepest thanks for your advice and support in the matter. This experience has taught me to be far more careful and to really just say no regardless of the person or pressure. 'Tea room' prescribing (such as writing prescriptions for colleagues… or their pets) is ethically and legally wrong with potential grave consequences. Politely declining these requests will not damage workplace relations, and in the end I am in a position of responsibility which should not be abused for any purpose. I am required to act appropriately and within my own professional limitations.

It has also taught me the benefits of private medicolegal defence cover. It helps greatly to have a medico-legal team that you can talk to knowing that they are solely there to protect your interests.”

Discussion

Qualification as a medical practitioner brings a number of privileges and responsibilities, including the ability to prescribe a large range of medications.  From the moment of graduation (and often even before this time), medical practitioners will be asked for professional advice and assistance by family members, friends and colleagues. Understanding and maintaining appropriate boundaries with respect to these requests is one of the many skills JMOs need to develop. Learning when to politely “say no” to these requests is difficult but essential.

If you are being asked to do something which you do not feel comfortable about, “saying no” may well be the best strategy, and seeking advice from an experienced colleague about what to do in the particular circumstances may save you a great deal of anguish.

Dr Sara Bird, Manager, Medico-legal and Advisory Services