A painful experience

An FY2 was sharing a house with several friends from university. One housemate had been taking over-the-counter anti-inflammatories for several weeks after sustaining a knee injury. She pleaded with the doctor to prescribe her something stronger to address the pain as she could not take time off work to attend a GP appointment.

After repeated nagging, the doctor reluctantly agreed to write a private prescription for naproxen but stressed this was a one-off. A few days later, the housemate collapsed with a GI bleed and was rushed to hospital where she had a blood transfusion and quickly stabilised. 

When the treating consultant discovered that the doctor had issued a prescription for naproxen, he made a complaint and the trust began an investigation. She was also told that the GMC would be informed. The doctor was deeply distressed about what had happened to her friend and the implications for her career and called the MDU. 

What happened next

The medico-legal adviser sympathised the doctor had been in a really difficult position. However, she needed to recognise and address several understandable concerns about her fitness to practise in relation to safe prescribing.

In particular, the GMC explicitly states that where possible doctors must avoid prescribing for anyone with whom they have a close personal relationship. Even if the doctor had been faced with a really exceptional need, such as a health emergency, they would still need to take as much care in prescribing as they would for any patient. That includes making a proper assessment and making sure they have enough information on which to base a safe prescribing decision, which can be very difficult with someone who is close. The doctor must also make a clear contemporaneous record of their relationship with the patient, the reason for prescribing and the patient's consent, and should inform the GP if the patient agrees. 

The doctor realised she had fallen short of the standards expected of a foundation doctor. She felt terrible about it, apologised and sought to reflect and improve her practice, including completing further training in prescribing.

The doctor had to submit a response that set out what had happened and her efforts to remediate. Fortunately for her, she was allowed her to continue her training with a warning about her conduct. The GMC closed the case with advice after the doctor had explained her deep regret, insight into the patient safety implications of what she had done, and what she had done to learn from the experience.  

Take home messages

  • You are responsible for all the prescriptions you sign.
  • Avoid prescribing to yourself, your friends, family and colleagues.
  • Check the patient's medical history and current medication for allergies, contraindications and other red flags. 
  • Talk to the patient about the medication, possible risks and what they should do if they experience side effects.
  • Reflect on your mistakes and what you have learned from them. 

This page was correct at publication on 13/05/2021. 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.