Treating family, friends or colleagues

The Board’s position is that whenever possible, avoid providing care (including prescribing) to family, friends and colleagues, because in most cases it is inappropriate. We do see the Board taking action in notifications about the provision of such care (particularly outside a formal consultation). Care can be negatively impacted because of:

• a lack of objectivity
• the possibility of inadequate or incomplete assessment with no medical records
• discontinuity of care
• the patient feeling uncomfortable sharing sensitive information
• principles of informed consent that may not be followed.

Additionally, practitioners risk breaching the specific, varying, and complex legislative restrictions on self (and family) prescribing in the various jurisdictions. This ranges from full self-prescribing prohibition (Victoria) through restrictions on self-prescribing Schedule 8 drugs (most jurisdictions) and some Schedule 4 medicines (Queensland, ACT, NSW, potentially WA/NT); or prescribing Schedule 8 drugs to classes of relative (SA). Such breaches may be criminal offences.

MDA National is well aware of regulatory authorities, such as Ahpra, taking action against practitioners who prescribe to close friends, family, and those they work with. Pharmaceutical regulatory authorities regularly audit prescribing and do report breaches of their prescribing legislation to regulatory bodies.

Say “no” to requests from family and friends for treatment/prescriptions. It’s only considered ethically and professionally appropriate to treat/prescribe in an emergency.

Consider in advance how you might refuse a request to provide a prescription e.g. “Professional guidelines mean that I’m not able to prescribe for family and friends”.

You can still support family and friends by acting as a well-informed patient advocate and facilitating care from an independent doctor, without taking on the role of the treating doctor.

We recommend that staff are not patients at the practice and to avoid treating staff members and their families wherever possible. This may be unavoidable in rural and remote areas. If you’re working in a rural environment, are there other practitioners in or near the community that the person can be referred to? If not, there’s an ethical obligation to provide care to underserviced patients.

Workplaces should have a formal policy about staff treating staff that discourages examination or prescribing without a referral except in emergencies or in rural and remote areas where it’s unavoidable. If there’s no policy in your workplace, useful questions to ask yourself before deciding to treat a staff member or colleague include:

• Will this person disclose relevant sensitive information?
• Will your knowing personal health information about this person impact the workplace?
• How will agreeing or not agreeing to treat a staff member impact the working relationship?
• In an informal consult, will you have all necessary information and resources to provide optimal patient care?
• Will there be a discontinuity of care?

In addition to the risk of breaching various prescribing legislation relating to self-prescribing, the Medical Board Code of Conduct, at 11.2 states that Good Medical Practice involves:

• 11.2.1 Having a general practitioner.
• 11.2.2 Seeking independent, objective advice when you need medical care, and being aware of the risks of self-diagnosis and self-treatment.
• 11.2.5 Not self-prescribing.

Self prescribing may lead to regulatory authorities pursuing the practitioner for inappropriate professional practice by way of breach of the Code of Conduct.

More information can be found in this MDA National article Physician Heal Thyself.