Informal advice or crossing a line?

AS a doctor, it is almost considered ‘part of the job’ to be asked for your medical opinion outside of work or by someone who is not a patient. We have all been there. Standing at the school gates, in the middle of a supermarket or even at a dinner party and being shown a rash, lump or bump. Sound familiar? Whilst it may be easy to signpost a parent at your child's school or a neighbour to their own GP or specialist, what happens when the advice being sought is from a fellow doctor?

Giving advice to other doctors

There has been a growing trend of doctors being asked for, or providing their professional opinion outside the clinical setting. This is often visible on social media platforms where doctors can post under an anonymous username.

Requests for advice could include: can I get some advice on my child’s rash? My mother went to see the GP, can I check that their advice and management plan is OK? Can you look at my X-ray and tell me what you think? Or even, I’m waiting in the emergency department, do you know someone who is working in this hospital who can help me?

It may seem that providing professional advice to a colleague - anonymously or not - is reasonable. After all, they are not someone you have a close relationship with. And perhaps they feel they are saving an NHS appointment by asking for help in this way?

GMC guidance

General Medical Council guidance clearly states that doctors must “avoid providing medical care to yourself or anyone with whom you have a close personal relationship”.

In terms of someone with whom you do not have a close personal relationship, it is generally wise to exercise caution and consider whether your informal advice, whether on social media or in person, may be construed as providing medical care.

Remember:

• Whilst you may not be providing a prescription or treatment, providing advice to someone informally is still fraught with difficulty. In such situations, you may not have access to all the relevant medical information to correctly diagnose or advise, but you will be responsible for the advice you give and any implications.
• Patients need proper clinical review and investigation by an impartial doctor. This type of care cannot always be provided informally, especially if you are interacting online or have no access to medical records.
• A doctor should not approach you to provide medical care informally for their convenience. They should be encouraged to seek advice from an impartial clinician who can assess, diagnose and treat their ailment appropriately and safely.
• Doctors, like other patients, are also entitled to a second opinion.

If you find yourself in the role of a patient questioning the advice of your doctor, you should raise this with them and explain why you feel a second opinion would be beneficial. If you’re online and see a post seeking your professional advice, please be mindful that in trying to help a fellow professional, you may be opening yourself up to criticism for advising in this way.

Doctors must always be careful to behave professionally, particularly in relation to patient confidentiality. You should also be mindful that even if this advice is informal, you are accountable for your opinion and the advice you give. There have been cases where some doctors have been reported for their online opinions, the advice they have given and the comments they have made.

Please be mindful that the GMC take these matters seriously and may investigate a doctor if they have concerns about their fitness to practise.

KEY POINTS

• Treating those close to you is fraught with difficulties, largely caused by the lack of objectivity. The GMC states that doctors must avoid this except in very rare circumstances.
• Even advising those with whom you do not have a close relationship can bring professional challenges for the doctor.
• If you are put in a position where you are asked for informal advice, whether in person or online, it may be worth suggesting that the person seek advice from a healthcare professional who has access to their clinical records and can appropriately assess, examine, diagnose and treat their condition.