Setting patient boundaries when you’re the patient

Nov 28, 2017

I knew I had a UTI. I could leave work sick and hopefully obtain an appointment with a general practitioner (GP), but I would have to travel to the practice, wait and describe my urinary symptoms to a colleague. I may also be out of pocket. Alternatively, I could save time, write myself a quick script and head straight back to work. The choice at the time did not seem a difficult one. I did what many doctors do and treated myself.

Most of us intrinsically know the dangers of self-prescribing when it comes to S8 and SD4 medications and indeed there are legal prohibitions in some states and territories regarding self-prescribing. However, many of us are less clear when it comes to antibiotics, the pill and other ‘everyday’ medications. There is also the temptation to order a routine blood test, or as one secretary suggested when I called to make a specialist appointment, “you could just write yourself a referral, most of our doctor-patients do”.

Studies show that self-treatment is common; the 2008 AMA Survey Report on Junior Doctor Health and Wellbeing reported that 38% of respondents had self-prescribed or medicated during the previous year, with antibiotics the most common script. Other studies put the rate of self-prescribing as high as up to 90% (Kay et al 2005, Hem et al 2005).

The Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia (the code) states that good medical practice involves “having a GP” that is not you, and “seeking independent objective advice when you need medical care and being aware of the risks of self-diagnosis and self-treatment” is also part of the code.

Just as we have boundaries with our patients, we need to have clear boundaries with ourselves. To set these boundaries self-prescribing shouldn’t be reflexive and we should ask ourselves the following questions:

Why am I self-prescribing?

One of the key questions you should ask yourself is why are you self-prescribing instead of going to a GP? At Avant, we often see doctors who appear before regulators and are asked about whether they have a regular treating GP.

My friend once asked a group of us at dinner about a lump on her leg. We assessed the lump and decided it was likely benign, but recommended that she got a more formal review with a GP. She decided to order an ultrasound herself, instead.

Like many doctors, she probably felt she was being a hypochondriac. She may have feared going to the GP as they might dismiss her and make her feel foolish or neurotic, and that as a doctor, she ‘should know better’. As discussed in the 2008 AMA Survey Report on Junior Doctor Health and Wellbeing, there is also an aspect of our medical culture which shows that doctors may find it difficult to discuss their own illnesses.

Are you giving your treating GP all the information they need?

As per the code, it’s important for doctors to have an independent GP. If you do, you should ask yourself whether you are giving your GP all the information they need as your treating doctor?

Self-prescribing and infrequent GP visits may be setting the situation up for failure. It does not foster the opportunity to establish trust or allow the GP to build a comprehensive clinical picture, therefore, on the infrequent occasions you do visit the GP you can end up unsatisfied with the result.

Is this the medical culture I want?

Finally, we should ask ourselves: Is this the medical culture that I want? I remember dragging myself into hospital one morning after enduring the night with food poisoning. I still felt terrible, but I felt a responsibility to my colleagues and patients, and didn’t want to appear as being weak. As the jobs piled up, I began to resent being there. I was responding to the pressure I felt to ‘solider on’, however, I was also contributing to this culture myself.

If I had taken an afternoon off to go to the GP for my UTI, my patients would have been okay and my colleagues’ likely understanding. If I had relieved myself of the burden of self-treatment instead and further enhanced the relationship with my GP, perhaps this wouldn’t have been such a waste of time after all.

More information

Read our articles:

‘How to be a better patient.’  

‘But it's just a script: prescribing requests for families and friends.’  

‘Doctor disciplined for inappropriately treating family members.’  

Visit our Doctors’ Health and Wellbeing website for health and wellbeing information, support and advice and see our list of key support services.

If you would like further information on this issue or any other issues, visit our website or for immediate advice, call our Medico-legal Advisory Service (MLAS) on 1800 128 268, 24-7 in emergencies.

References

  1. Hem Erlend, Stokke Guro, Tyssen Reidar, Gronvold Nina, Vaglum Per, Ekeberg Oivind ‘Self-prescribing among young Norwegian doctors: a nine-year follow-up study of a nationwide sample’, BMC Medicine, December 2005 3.16.
  2. Jammal W. ‘But it's just a script: prescribing requests for families and friends.’ Avant 2015.
  3. Kay Margaret, Mar Chris, Mitchell Geoffrey ‘Does legislation reduce harm to doctors who prescribe for themselves’, Australian Family Physician Vol 34 No1/2 January/February 2005.
  4. Montogomery A.J, Bradley C, Rochfort A. Panagopoulou ‘A review of self-medication in physicians and medical students’ Occupational Medicine Advance Access July 4 2011.
  5. Medical Board of Australia. Good Medical Practice: A Code of Conduct for Doctors in Australia. Issued under section 39 of the Health Practitioner Regulation National Law. 2010, revised 2014.
  6. Young Simon, Physician (don’t) heal thyself. Australian Doctor 5th November 2015. https://www.australiandoctor.com.au/clinical/therapy-update/physician-don-t-heal-thyself 

Share your view

We welcome your feedback on this article – email the Editor at: editor@avant.org.au