The pitfalls of treating work colleagues

Blurred lunes

People who don't work in general practice might be forgiven for thinking that one of the perks of working for a GP is having swift access to medical attention. But treating work colleagues is generally discouraged, for sensible reasons. MDU medico-legal adviser Dr Sally Old explains the pitfalls.

Treating colleagues is tricky for GPs because a close personal relationship with patients makes it very difficult to maintain clinical objectivity, subverting the normal doctor-patient relationship. For instance, would a GP be able to put their irritation aside when seeing a receptionist who had attracted several complaints about her attitude? If an employee has taken sick leave, might they be tempted to provide treatment that they would not usually provide in order to help them return to work?

For their part, employees may also find it more difficult to talk openly about their health with someone they see every day in a different capacity, not least because of concerns about confidentiality.

There is also the potential for conflict within the practice if concerns are raised about an employee's performance, especially where there are health implications. It is difficult to approach employment issues objectively if a GP is aware of relevant information that they learnt in a private consultation. Equally, a GP's ethical duty of patient confidentiality means this cannot be considered without the patient's consent. Any breach of the employee/patient's confidentiality could prompt a complaint to the GMC or a claim to an employment tribunal.

Informal prescribing to colleagues

GPs who prescribe medication for their practice colleagues on an informal basis are also taking a significant professional risk with implications for their practice colleagues who would have to pick up the pieces.

The GMC has long discouraged doctors from treating anyone with whom they have a close personal relationship, and recently tightened its guidance which now states: "Wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship." Controlled drugs must not be prescribed to those with whom the doctor has a close relationship except in exceptional circumstances such as where it is necessary to save a life or alleviate uncontrollable pain or distress. The GMC expects doctors who prescribe for someone close to them to make a clear record justifying why there was no alternative, and also inform the other person's GP about which medicines have been prescribed, unless the other person objects.

No alternatives

Of course, there may be practices, such as those in remote rural communities where employees do not have easy access to alternative medical care. If treating employees is unavoidable, the practice should ensure they are aware of the potential pitfalls that such arrangements might create, including difficulties with confidentiality and remaining objective.

Practices in this situation can seek specific advice on the ethical implications from us. Our medico-legal team is available between 9am-5pm Monday to Friday and provides an on-call service for medico-legal emergencies or urgent queries 24 hours a day, 365 days a year.

Case scenario

A practice receptionist sought urgent advice from a GP colleague because she had an attack of cystitis, including traces of blood in her urine and she was unable to concentrate because of the pain. The receptionist revealed she had had cystitis before so the GP advised her to drink plenty of water, take some painkillers and suggested she might also need a course of antibiotics to clear up the infection. Explaining that she didn't want to take time off work to attend her own doctor, the receptionist persuaded the GP to prescribe amoxicillin.

Unfortunately, the receptionist developed a rash and it was discovered she was allergic to penicillin. The receptionist was embarrassed at not remembering she could not take penicillin and did not want to make a complaint.

When the incident was investigated within the practice, it was agreed it wouldn't have happened if the receptionist had attended her own practice where the GP would have had access to her notes. The practice manager and senior partners agreed to implement a policy requiring staff members to see their own doctor if they were unwell.

This article originally appeared in the print version of inpractice December 2013 issue entitled 'Blurred lines'

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