As doctors, we may sometimes feel that we are never off duty. Even when we are not at work, those close to us may seek our advice on medical matters, or even request for emergency medical assistance. Dr Rachel Birch, Medicolegal Consultant at Medical Protection, addresses this issue in more detail, presenting two examples of common scenarios that doctors may encounter.
Case 1: “I know you are not at work, but….”
Dr F works part-time as a sessional GP to have a better work-life balance. One of her friends has a son called Jamie, who is in the same class as her twins. She approaches Dr F at the school gate and tells her that she has taken Jamie to his GP earlier, as he has a nasty cough. The GP did not give Jamie antibiotics and Dr F’s friend is looking for a second opinion. She sees that Dr F has her doctor’s bag with her and asks her to listen to Jamie’s chest.
How should Dr F handle this request?
This scenario is not uncommon. Friends or family may not see an issue with asking you, the GP, for advice about their recent doctor’s visit, and may even believe they can approach you for treatment.
In the first instance, it may seem like an innocent request and Dr F may find herself reaching for her stethoscope. However, there are risks, not least the fact that it would be difficult to be fully objective, to separate her relationship with her friend from any clinical assessment she made of her son. This could result in harm, since she might under-assess his illness in an attempt to reassure her friend. It could also mean that her friend expects her to assess Jamie every time he is unwell.
“In providing clinical care you must, wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship.”
In any situation where doctors actually treat either themselves or someone close to them, the GMC advises they must take two actions:
They must make a clear contemporaneous record or as soon as possible afterwards, documenting their relationship to the patient and the reason it was necessary for them to prescribe.
They must tell their own or the patient’s GP and other treating doctors what they have prescribed and any other information necessary for continuing care, unless (in the case of prescribing for somebody else) they object.
The above two principles would apply equally when assessing a patient as well as prescribing for them.
The GMC makes it clear that doctors should not treat themselves or close friends or family, except in the most emergency situations.
What should Dr F do?
- Dr F may listen to her friend’s concerns as a friend – not in the capacity of a doctor – and offer support at what may be a worrying time for her.
- She may wish to suggest that her friend contacts the GP practice, to arrange for a second opinion on Jamie’s chest.
Case 2: “Is there a doctor on board?”
Dr A is travelling to Spain with three friends for a long weekend. They have a meal at the airport and a couple pints of beer each before boarding their flight. About halfway into the flight, a cabin crew announces: “Is there a doctor on board?”.
Without a moment’s hesitation, Dr A presses the call bell. He is asked to assist a male passenger at the back of the plane who is experiencing chest pain. He introduces himself and the man tells him that he has been having central crushing chest pain on and off all day. The man initially thought it was related to the anxiety of flying, but the pain has persisted into the flight.
As Dr A is talking to him, the man’s chest pain goes away within about 10 minutes. Dr A suggests that the patient takes 300mg dispersible Aspirin and arranges for oxygen to be delivered by mask for the remainder of the flight as he stays with the man. Dr A asks the captain to arrange an ambulance to meet the patient upon disembarking the plane. The man is fine for the rest of the plane journey.
In his hotel room later that night, Dr A feels worried wondering if he has done all the right things for the man, and whether he could face criticism if the patient is found to have had a heart attack. He wonders if he would be indemnified in the event of a clinical negligence claim.
- Off-duty medical assistance as such is known as the “Good Samaritan Act”. This means that Dr A has provided medical assistance free-of-charge in a medical emergency that he chanced upon in a personal capacity.
- While there is no specific legal duty for doctors to assist during a medical emergency in the UK, doctors do have an ethical and a professional duty to help.
“You must offer help if emergencies arise in clinical settings or in the community, taking account of your own safety, your competence and the availability of other options for care.”
Before offering to help in an emergency, doctors should consider whether there are any factors that might compromise their competence – alcohol, medication or tiredness – and proceed accordingly. Doctors should do the best that they can in the circumstances with the resources available, working within the limits of their competence.
In the case above, Dr A has had two pints of beer earlier in the day, but it appears that it did not impair him from offering help in an emergency. The care he provided appears to be in line with what another GP would have reasonably done in that situation.
It is prudent for any doctor who treats a patient, as a Good Samaritan Act, to make contemporaneous notes, or notes as soon as possible afterwards. If the patient agrees, a copy could be sent to their own GP for the purpose of continuing care.
If in doubt, GPs should contact their medical defence organisation to ensure that they have appropriate indemnity for Good Samaritan Acts, since this is not provided by the Clinical Negligence Scheme for General Practice.
I received helpful correspondence regarding Case 2 in this article and thought it might be helpful to clarify a few points:
- This is a fictitious scenario, where Dr A has made the assessment, himself, that he was fit to offer help to the male passenger despite having drunk two pints of beer earlier that day.
- This article was in no way intended to suggest that it is my opinion that Dr A was fit to provide assistance- that is a matter for the individual doctor at the time.
- It was pointed out to me that when a person has drunk alcohol, this may actually impair their ability to make a judgment on whether they are impaired by alcohol.
- When drinking alcohol before a flight, doctors may wish to consider, before any potential emergency situation, whether they feel they would be fit to offer help in an emergency. It may be also helpful to seek the views of anyone they are travelling with.
Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.