One SHO's dilemma demonstrates the difficulties that self-prescribing can create
The scene
An F2 working in a busy surgical job at a local hospital called the MDU advice line one afternoon after she had received "a worrying letter from the GMC" that morning. She told the MDU adviser that a local pharmacist had written to the GMC expressing concerns about a prescription she had written for herself for diclofenac 25mg tds and diazepam 2mg.
The doctor explained that she had been prescribed diclofenac a few weeks before by her GP when she had had severe back pain. The pain continued but she was too busy to make a follow-up appointment. She said that she had written a private prescription on a blank piece of paper, and added the low dose benzodiazepine for short-term use as a muscle relaxant to help her cope with a long flight to Australia.
She was surprised that the pharmacist had dispensed her prescription without expressing any concern to her, but had then written to the GMC.
She sent a copy of the GMC's letter to the MDU, along with a draft of her initial thoughts on how to respond. Her medico-legal adviser explained that it is the GMC's normal practice to write to doctors' employers to ask if they have any other concerns about the employee's performance or conduct. Fortunately, it seemed unlikely that her employer would have other concerns.
MDU advice
The medico-legal adviser suggested that the doctor review the GMC's prescribing guidance and discussed with her the reasons behind it. These include the difficulties of making objective decisions about one's own health (especially with mental health problems). He also pointed out that diazepam is a Class C controlled drug under the Misuse of Drugs Act 1971, which the doctor had not appreciated. She was encouraged to do some background reading and an online course so that she could demonstrate, if necessary, that she had taken pro-active steps to update her knowledge of safe prescribing.
The GMC's core ethical guidance states that doctors should not, in general, treat themselves or people to whom they are close. Specifically, Good medical practice (2013), paragraph 16g says you must: 'wherever possible, avoid providing medical care for yourself or anyone with whom you have a close personal relationship.'
The GMC also publishes more detailed guidance in Good Practice in Prescribing and Managing Medicines and Devices (2013).
Outcome
With the MDU's advice, the doctor reflected on what she had done and drafted a letter to the GMC. In this, she explained her reasons for self-prescribing, indicated that she now understood that it had been unwise and detailed her reflections on the matter.
The GMC closed the case with advice to follow GMC guidance in future.
Dr Philip Zack
Medico-legal adviser
This page was correct at publication on 10/01/2014. 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.