Inappropriate prescribing

A recently qualified junior doctor was doing his final surgery in general practice before going on a skiing trip to America. He was keen to get home to pack following the late surgery session. 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 discomfort 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 GP he decided to use the practice prescription pad to write himself a prescription for opiate-based pain killers, which he would only take if, and when, absolutely necessary. He left the building and started walking to the pharmacy.

Before he got there, his mobile phone rang. It was a friend who was also going on the skiing trip. The junior doctor was aware his friend had been off work with flu; he was concerned he was developing a chest infection and described a productive cough to the junior doctor. His friend asked if he could prescribe antibiotics for him. He went back into the practice to write another prescription.

At the airport, the junior doctor gave his friend the antibiotics so he could take his first dose before getting on the plane. Unbeknown to him, his friend was allergic to penicillin and had a severe 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.

Back at work, he was called in to see his GP trainer who was very concerned he had prescribed for another person having not taken a history, examined the patient, made a diagnosis or enquired about their past medical history, current medication or allergies. The trainer asked him to reflect on his actions and review the GMC guidance on prescribing; particularly paragraphs 17 to 19. Meanwhile, the trainer would decide whether any further action was necessary.

The junior doctor was alarmed to read the GMC guidance on self-prescribing, particularly paragraph 18 which referred to controlled medicines. He immediately informed his trainer that he had also prescribed opiate-based medication for himself to relieve his back pain, but had not taken any. He returned the unused medication to the pharmacy and apologised for his actions.

As the junior doctor had acted in good faith and admitted to and apologised for his actions, 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. The junior doctor also attended a prescribing course which he could then record in his GP e-portfolio.

This is a fictional case compiled from actual cases from the MDU's files.

This page was correct at publication on 20/01/2014. 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.


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