The scene
A recently qualified junior doctor was doing his final day in general practice before going on a skiing trip. He was keen to get home to pack after a late session, but a few days earlier he had slipped on ice and twisted his back. Paracetamol and ibuprofen weren't relieving the pain, and he was concerned about being in pain on the flight and while skiing.
The only other doctor in the practice at the time was still seeing patients. As the junior doctor didn't have time to see his own GP, he decided to use the practice prescription pad to write himself opiate-based painkillers, which he would only take if, and when, absolutely necessary.
Just as he was leaving to go to the pharmacy, his mobile rang. It was a friend who was also going on the skiing trip but had a productive cough after flu and was worried she was developing a chest infection. The friend asked the junior doctor if he could prescribe antibiotics for her. He went back into the practice to write another prescription.
At the airport, the junior doctor gave his friend the antibiotics so she could take her first dose before getting on the plane. Unbeknown to them both, his friend was allergic to penicillin and had an anaphylactic reaction, collapsed and was admitted to hospital. The junior doctor was so upset by the incident that he decided not to go on the trip. He was also very concerned that he had prescribed the medication without checking whether his friend had any allergies.
MDU advice
The junior doctor called the MDU for support. He was worried about his friend but also knew he shouldn't have prescribed for her and was worried about what he might now face.
Together with the adviser, the junior doctor reviewed the relevant GMC guidance on prescribing. The junior doctor knew that doctors should only prescribe for patients when they have enough information to do so safely (including information about the indication for prescribing, medical history and allergies). This is difficult when the person is someone the doctor knows personally.
The GMC 's 'Good practice in prescribing and managing medicines and devices' states: "Wherever possible, you must avoid prescribing for yourself or anyone you have a close personal relationship with." (Paragraph 67)
It is never appropriate to prescribe for a friend, family member or yourself for convenience. On the rare occasions where prescribing for a friend is appropriate, the doctor must keep a proper record and usually also notify the person's GP.
Is it ever okay to self-prescribe?
The GMC guidance places extra safeguards for controlled drugs. It's only appropriate to prescribe for yourself or someone close to you if there is no other prescriber available and it's an emergency where treatment is required immediately to avoid serious deterioration. And as with any other prescription, the doctor must again keep a proper record and let their GP know.
Most junior doctors are also prevented from prescribing for themselves or those close to them due to the approved practice setting (APS) restriction on their GMC registration. This restriction remains until their first revalidation (usually five years after registration) or entry onto the specialist register. It mandates working solely in an approved practice setting, typically a training programme, with any other work requiring approval from the educational supervisor.
There have also been a number of cases where doctors who had self-prescribed, or prescribed for family or friends, had been investigated by the GMC after being reported by a pharmacist or someone else. In this case, the hospital team caring for his friend could have had concerns about where the antibiotics had come from.
Outcome
The junior doctor was surprised by the GMC guidance, but the adviser explained that doctors who make errors can mitigate criticism by being open and honest, saying sorry when appropriate and by learning from what has happened.
The junior doctor informed his trainer about having prescribed for his friend and himself, even though he hadn't taken any of the painkillers. He returned the unused medication to the pharmacy and apologised for his actions.
As this was a one-off and the junior doctor had admitted to and apologised for his actions promptly, his trainer did not take the matter further. He did, however, explain to the junior doctor that any further inappropriate prescribing would result in a referral to the GMC (even if the pharmacist or hospital team did not make a referral this time).
The junior doctor also attended a prescribing course, which he could then record in his GP e-portfolio, and kept detailed reflective notes of his learning from what had happened. The doctor also disseminated the learning during a regional training day attended by his peer group. Many of his colleagues were surprised to learn of the APS restrictions on their practice, and were reminded of the importance of prescribing safely.
The most important takeaway is to familiarise yourself with the GMC 's guidance.
This is a fictional case compiled from actual cases from the MDU's files.
This page was correct at publication on 17/04/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
by Dr Catherine Wills Medico-legal adviser
MA(Oxon) MB BS LLM FRCP MFFLM
Catherine joined the MDU in 2004 and is deputy head of the advisory department. Previously, Catherine was a hospital consultant in general medicine, diabetes and endocrinology.