Case Study

Nancy has been a receptionist at the practice for several years and sees the provision of the odd script or referral as convenient and a perk of the job.

John is the practice principal, and he interviewed and employed Nancy, so she would occasionally turn to John if she needed “something quick.” Nancy also visits one of a number of GPs at a large medical practice near her home.

John was shocked and surprised when he received an Ahpra notification which had been lodged by Andrew, one of the GPs at Nancy’s local practice.

The notification related to a script John had written for Nancy. Nancy asked for a one-off script for tramadol, which she said she had taken before for pain. John was unaware that Andrew had commenced Nancy on citalopram six months prior. Nancy didn’t tell John about her depression, or her use of citalopram, because she was concerned it might affect her reputation in the workplace.

When Nancy presented to ED with serotonin syndrome, Andrew became aware of the script John had written. Upon further questioning, Nancy admitted to Andrew that John had given her the script without asking any questions, including whether she had any current health issues or if she was on any medication.

Andrew made the notification on the basis of 4.15 of the Good Medical Practice: a code of conduct for doctors in Australia which states:

Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the patient and doctor. In particular, medical practitioners must not prescribe Schedule 8, psychotropic medication and/or drugs of dependence or perform elective surgery (such as cosmetic surgery), to anyone with whom they have a close personal relationship.

The Medical Board considered that the fragmented care put Nancy’s health at risk, and Ahpra reprimanded John after viewing his sparse notes, which simply said “Script for tramadol.”

Discussion

There are a number of barriers to providing safe care to staff members, including:

• an incomplete past medical history
• adequately protecting the privacy of the staff member’s personal health information
• a risk the consultation becomes a “corridor consult” with no notes being made
• the ability to remain objective, or a reluctance to perform a necessary physician examination
• a conflict of interest between your role as the treating doctor as well as being a colleague, or even a supervisor or employer.

A less common, but potentially serious problem can arise when a doctor is in an intimate relationship with a staff member of a medical practice or a hospital. If the relationship ends badly, it may be stressful but should remain a personal issue between the parties. But if the relationship is complicated by the doctor treating the staff member prior to start of the sexual relationship, then this may result in a mandatory notification to Ahpra on the basis of sexual misconduct. If the treatment includes issues around mental health or prescriptions for schedule 8 drugs, this can have serious consequences for the doctor.

Practices may wish to consider having a practice policy that staff members cannot be treated by the doctors at the practice. Notwithstanding such a policy, care should still be provided to staff in the event of an emergency.

This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy or medico-legal matters. Members can contact MDA National for specific advice on freecall 1800 011 255 or use the “contact us” form at mdanational.com.au.

This case study is based on an actual request for medico-legal advice, however certain facts have been omitted or changed to ensure the anonymity of the parties involved.