Dr Edward Farnan
With prescribing powers come certain responsibilities. Dr Edward Farnan highlights the situations to avoid and the guidelines to follow.
On becoming a doctor, you take on numerous responsibilities. You also acquire a number of rights, among these the right to prescribe medications.
A great deal of support will be available to you when you prescribe for the first time – senior colleagues, experienced nurses, the British National Formulary, GMC guidance, and other clinical guidelines all being examples. As you become more proficient, you will be able to rely more on your own experience, and less on other sources of support and guidance. It is, however, important to bear the relevant guidance in mind.
Blurring the lines
The fact that a doctor can prescribe means that it can seem convenient to prescribe for a friend, for family or even for yourself. Imagine the following scenarios.
A close family member has been troubled by severe back pain. They have seen their own GP, who has prescribed an anti-inflammatory. They come to visit you at a weekend, but have forgotten their medication. You write a private prescription on a blank piece of paper for a similar non-steroidal, and add a small amount of low dose diazepam for short-term use as a muscle relaxant, rather than have the relative contact the out of hours GP or a walk-in centre.
Alternatively, a doctor who is placed in a hospital far from their usual place of residence, and who hasn’t had time to register with a new GP might, during a busy period with antisocial shifts, decide that they do not have time to make an appointment with their own GP and might write a private prescription for their own regular medication – an inhaler for asthma, or insulin, for example.
In both of these scenarios, it is possible that the pharmacist to whom the prescription is presented will dispense the medication without expressing concern. The doctor may subsequently be surprised and distressed to learn that the pharmacist has written to the GMC, who in turn has opened a fitness to practice investigation.
Doctors who prescribe contrary to local guidelines or protocols may find themselves subject to an investigation.
Follow the guidance
The GMC has published extensive guidance on prescribing and the GMC’s core publication, Good medical practice advises that you must ‘wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship’.
The GMC expands on this core guidance in its publication, Good practice in prescribing and managing medicines and devices. This says that doctors who do prescribe for themselves or for someone close to them must ‘make a clear record at the same time or as soon as possible afterwards. The record should include your relationship to the patient (where relevant) and the reason it was necessary for you to prescribe’.
They must also ‘tell your own or the patient’s general practitioner (and others treating you or the patient, where relevant) what medicines you have prescribed and any other information necessary for continuing care, unless (in the case of prescribing for somebody close to you) they object’.
The first of the two examples given above might pose particular problems for the prescribing doctor, since diazepam is a Class C controlled drug under the Misuse of Drugs Act 1971. The GMC specifically advises that only in the most exceptional circumstances – to save a life, or to avoid serious deterioration in health, for example – should a doctor prescribe a controlled drug for themselves or someone close to them.
Even then, it should only be considered if no other person with the legal right to prescribe is available without life or health-threatening delay.