Risk in practice: treating friends and family

It is not unusual for family and friends to ask for medical-related “favours”, often wrapped up with a degree of emotional blackmail, intended or otherwise. Generally doctors are a sympathetic group and can find such requests difficult to refuse, even in the knowledge that treating family and friends is frowned upon.

GMC guidance is clear: “Wherever possible avoid providing medical care to yourself or anyone with whom you have a close personal relationship.”

This does not mean that you cannot, for example, provide an acute prescription for antibiotics when these are required promptly and when there is no alternative - your friend is travelling abroad in a few hours’ time and has a clear infection requiring treatment. There is no law against prescribing for those you know, but remember the correct type of prescription! However there are circumstances when prescribing for someone you know is fraught with difficulty.

Such circumstances occur where anything other than short term treatment is needed. The patients in these cases need proper clinical review and possible investigation by an objective clinician. This type of care cannot be provided by a friend who is a doctor and might be difficult to justify as being in the patient’s best interests. Convenience and best interests are not the same but patients will often confuse the two.

Any treatment involving medicines at risk of abuse or where medicines have an effect on the patient’s mental health are a “no go” area in treating those close to you and would be virtually impossible to justify before the GMC.

Guidance extends to all aspects of medical care and not just prescribing.

Beware of the friend or relative who makes an unusual request. As a rule, if thetreatment the patient is seeking falls outside normal practice you should politely refuse and seek the opinion of someone impartial. Sadly doctors do fall into this trap of trying to help when no one else will and when things go wrong (as they often do in such cases) not only are they criticised severely by the “friend” but also by the regulator. Friends who have suffered adverse consequences of treatment are often the most vocal and bitter when things don’t go according to plan.

However, the nature of medical practice is such that you may well have to treat someone you know at some point in your career. If so, it should not be too difficult to draw the line between someone you know and someone “with whom you have a close personal relationship”. If you are referred a patient who is too close to you, or it could be alleged that you are too close, and this might compromise their care, it is best to point this out (to management or colleagues as appropriate) and if possible have a colleague involved. If there is no alternative, ensure that you keep detailed records and do not take shortcuts in the patient’s management. Your records must demonstrate that you have acted in accordance with good practice and would justify any investigation or treatment plans you have put in place.

Each year a significant number of doctors are reported to the GMC for prescribing to someone they know – pharmacists are quite vigilant in this regard and will copy to the regulator any prescription about which they have concerns. The more simple cases can be resolved by providing a clear explanation, evidence that the action was reasonable and confirmation that the doctor knows and understands their professional duty.

However, there remains a significant group of doctors whose prescribing to, or treatment of, family or friends raises sufficient concern for the GMC to investigate more fully. Some of these will be accepted as not so unreasonable in the particular circumstances, but may still attract a formal warning. Others unfortunately proceed to full investigation and hearings which often result in serious penalties. Usually these begin with good intentions when the doctor thought they were helping in a sensitive way.

Treating those close to you is fraught with difficulties, largely caused by the lack of objectivity. And if it is shown that your actions were not in the patient’s best interests, the penalties can be severe.