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GP retires after inappropriate prescribing

23 June 2021 | Dr Patrick Clancy, MBBS FRACGP MHlth&MedLaw, Senior Medical Adviser and Georgie Haysom, BSc, LLB (Hons), LLM (Bioethics), GAICD, Head of Research, Education and Advocacy, Avant

A GP, who prescribed various Schedule 4 and 8 drugs to two patients with a history of drug dependence, has been reprimanded and found to have engaged in professional misconduct.

The decision highlights the issues, risks and obligations around prescribing drugs of dependence, particularly where patients have a history of drug dependence or may be doctor shopping.

The doctor who is of retirement age, surrendered his registration and gave notice of his intention to retire from medical practice, and was also disqualified from applying for re-registration for nine months.

Recognising a history of drug dependence and doctor shopping

The Tribunal stated the doctor was aware that both patients had “a history of drug dependence” and “were recovering Methadone addicts.” In one case, the doctor was also aware of “potential doctor shopping behaviour” but prescribed the drugs anyway.

The tribunal held his prescribing to be inappropriate in that he failed to adequately consider the appropriateness of or risk in prescribing the medications – which included Panadeine Forte, Serepax, MS Contin, Physeptone, Targin and diazepam.

Recognising whether a patient is or was drug dependent and whether they are exhibiting drug-seeking or prescription-shopping behaviour is critical when prescribing drugs of dependence.

Take a full patient drug history and register for access to Medicare's Prescription Shopping Information Service. This service will advise if a patient meets specific criteria for the number of prescribers and prescriptions – you can contact them 24 hours a day, seven days a week on 1800 631 181 for information about a patient’s habits and prescriptions.

Many states and territories either have or will introduce a system of real time monitoring.

Legal requirements for prescribing certain drugs

In this case, the doctor also failed to obtain the necessary authorisation. Before prescribing certain drugs, you may require approval from the relevant state or territory authority.

These requirements vary slightly, so familiarise yourself with the regulations where you practise. If in doubt, contact your local pharmaceutical services authority for further information.

For drugs of dependence, you require specific approval before prescribing to a patient for more than two months, or if a patient is drug dependent.

The importance of proper consultation, care, decision-making and record-keeping

Another feature of this case was a failure to follow best practice guidelines when prescribing medications.

The tribunal made it clear that, when prescribing, you should always conduct a proper consultation, undertake a medical assessment, diagnosis, and consider the likely risks and benefits of the medication, along with alternative interventions and a management plan.

Also, consider other factors such as any mental health issues or excessive alcohol consumption, and document adequate evidence of clinical indication, assessment and decision-making.

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. Only prescribe medications after a proper consultation and where therapeutically indicated.
  • When prescribing drugs of dependence, take a history of previous drug use and consider this in decision-making.
  • Be vigilant and alert to drug-seeking and doctor shopping behaviour in patients when prescribing drugs of dependence.
  • Understand when authorisation is required for prescribing a drug of dependence and what other legal requirements for prescribing medications exist in your state or territory.
  • Always maintain clear, up-to-date medical records that include details of a patient’s clinical history, your clinical findings, investigations, assessments, information provided to the patient, medical details and treatment and management plan – in a form that can be understood by other health practitioners.

Resources

eLearning course: Prescribing principles: Chapter one - general prescribing issues- 3 RACGP activity points 225785. ACRRM 2 hours PDP content ID: 21059

eLearning course: Prescribing principles: chapter 2 - opioids and other drugs of dependence - 3 RACGP activity points 225790. ACRRM 2 hours PDP content ID: 21063

Opioid prescribing related claims

For advice on prescribing drugs or other medico-legal advice please contact us on nca@avant.org.au or call 1800 128 268, 24/7 in emergencies.

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