A recent disciplinary case has
reinforced the risks associated with mixing your duty as a doctor with your
family obligations. A doctor specialising in mental health disorders has been
found guilty of professional misconduct for treating family members.
Houston* had been practising for more than 30 years in private practice and for
a community mental health service, with no prior disciplinary record or
conditions on their registration.
Tribunal draws the line on nature of
The tribunal found that over a five-year period, Dr Houston
provided wrongful and inappropriate prescriptions to their two adult children
and spouse, including Schedule 4D drugs. The doctor also self-prescribed by
issuing prescriptions in their spouse’s name for medication that they consumed,
and failed to maintain appropriate clinical records and communicate with other
treating doctors regarding the treatment.
Unusually, the conduct issues
were confined to the doctor’s family members and there was no evidence of any
inappropriate conduct in their day-to-day treatment of patients. The
prescriptions provided to family members were also within clinical standards in
terms of medication choice and dose.
Dr Houston admitted to all of the
allegations and conceded that the conduct in question constituted unsatisfactory
professional conduct. However, submissions were made on behalf of the doctor
that the conduct did not amount to professional misconduct. Under the Health
Practitioner Regulation National Law (NSW), professional misconduct is found
to have occurred where the conduct is considered more serious than
unsatisfactory professional conduct, warranting suspension or cancellation of
the doctor’s registration, or where there are repeated instances of
unsatisfactory professional conduct, amounting to sufficiently serious conduct.
Treatment of family members only acceptable in an emergency or
In handing down their decision, the tribunal referred to the
Medical Council of NSW’s Guidelines
for self-treatment and treating family members (The guidelines) which
supplement the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for all Doctors in
Australia (The code).
In the words of the tribunal, there are some
“narrow limits” which override the impropriety of doctors treating their family
members and themselves, including emergency or necessity. The guidelines
- Where no help is available in an emergency or
isolated settings, a doctor may treat themselves or their family, but only until
another doctor becomes available
- There are circumstances where a doctor
may work together with an independent doctor to maintain established treatment
for themselves or their family members, but should not be their primary or
regular care provider.
Misplaced sense of responsibility to
While the tribunal acknowledged the extreme and chaotic nature of
Dr Houston’s domestic situation, it ultimately found the doctor guilty of
professional misconduct. The doctor’s conduct went beyond the exceptions
outlined above and was seen to come from a misplaced sense of familial
responsibility, which conflicted with professional obligations as a doctor. Dr
Houston was reprimanded and ordered to undergo medical ethics education and
mentoring by a psychiatrist.
Agreeing to prescribe
for family members may be driven by wanting to help your family,
particularly if the patients are your children, or you may feel pressure from
your relatives to treat them. However, there is often an inherent conflict
between your obligations as a doctor and your relationship with your family. For
example, doctors who treat family members may be affected by subjective emotions
which hamper their ability to provide the best treatment. So, where possible,
avoid mixing the two, and remember:
- It is not advisable to treat any family members, or yourself.
- If there is an emergency or necessity to treat a family member, provide only
the treatment required and then handover care to an independent doctor.
- If necessary, you can collaborate with a relative’s treating doctors, but
you should not be their primary doctor.
- If you do need to provide
treatment to a family member, document it and communicate with their other
- It is a good idea to have your own independent GP.
*The doctor’s name has been changed to protect privacy.
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