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    Issue 16

  • Small but significant

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    What’s colouring your thinking?

     
    J Matthews

    Justine Matthews

    LLB

    Solicitor, Professional Conduct

    Avant Law
     
    colouring your thinking main image

    Sometimes a doctor’s desire to help a patient when empathising with their situation can backfire. Knowing when to say no and remain supportive, can often avoid medico-legal issues down the track.

    An experienced GP* admitted a patient’s religious or cultural expectations clouded her decision-making when she prescribed herself Schedule 8 and Schedule 4 drugs to provide to a leader in a religious community.

    It was late evening when the patient contacted the doctor for assistance with a severe cough that had prevented him from sleeping. The doctor understood he was prohibited from handling money due to his religious beliefs and reliant on her to procure the medicine on his behalf.

    Naturally, the doctor wanted to help, so she went to her practice to write a script but couldn’t find a medical record for the patient. Mindful the pharmacy was about to close, she hastily decided to write a prescription in her own name for codeine and a corticosteroid. She filled the prescription and delivered the medication to the patient that night.

    Soon after, she received a letter from the state’s medicine compliance unit reminding her there is a regulation prohibiting self-prescribing of S8 and S4 controlled and restricted drugs. She was informed a breach of the regulations could result in disciplinary action and was asked to respond.

    Error in judgement

    Our medico-legal team helped the doctor respond and suggested she include the text message she received from the patient on the evening in question, and a statement confirming he received the medication, unopened.

    The doctor accepted full responsibility for her error in judgement and explained religious and cultural expectations had coloured her decision-making. She committed to never repeating the mistake.

    The medicine compliance unit determined the doctor had breached the regulations. She failed to record the name and date of birth of the person for whom the medicine was prescribed, had made an entry in the records that was knowingly incorrect, and presented the prescription in her name with the intent to provide the medication to another person.

    Since the doctor had never self-prescribed before and willingly admitted her error, the medicine compliance unit took no further action, but committed to ongoing monitoring of the doctor. They also noted the patient had been informed this could not happen again.

    Managing expectations

    When facing insistent patients, religious or cultural expectations, it’s important to maintain your professional judgement when prescribing drugs of dependence.

    If a patient is pressuring you to bend the rules, be careful not to compromise yourself, no matter how reasonable the request. State how it’s against practice policy or the law, so the patient understands it’s not personal to them. Remember, you are required to comply with the legal and regulatory requirements in your state, and it’s you that could end up facing the consequences if you don’t.

    Key lessons

    • Maintain your professional judgement when facing patient pressure or needs that compromise your professionalism.
    • Explain the refusal is not personal and consider alternative solutions for the patient.
    • Comply with your state’s relevant drug prescribing guidelines and legislation. Doctors are prohibited from self-prescribing S8 and S4 drugs of dependence.
     
     

    Useful resources

    Treating family members, friends or staff
    Opioid prescribing-related claims
    Prescribing principles and practices: chapter 2: opioids and other drugs of dependence
    Visit the Avant Learning Centre

    *The details of this case have been changed for privacy reasons.

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