Why you shouldn’t treat staff or family

23 October 2018 | Sonya Black, LLB (Hons), B.Com, Special Counsel – Employment, Avant Law, QLD and Vinay Pandaram, LLB BComn GDLP, Senior Claims Manager, NSW, Avant

Over the 12 years Sally has been employed in your practice, you have treated her, her husband and her four children.

The decision to dismiss her, after you discovered she stole money from your practice, was extremely difficult.

This was compounded by the relationship you had developed with Sally and her family, both professionally and as their doctor.

Now you’re wondering whether you should be treating staff or their family members.

Treating people you know

Doctors should avoid treating staff, practice colleagues and their families as far as possible.

This can be difficult in, say, a rural practice, where another doctor is some distance away.

If that is the case, you should consider putting in place extra measures to minimise the risks you might be exposed to.

What are the risks?

1. Privacy

A staff member accessing another staff member’s medical record, whether on purpose or inadvertently, would be a breach of privacy. This may also be a notifiable data breach.

The situation could become even worse if the staff member who accessed the medical record discusses it with other people.

This can lead to difficulties in the workplace and the need to take appropriate disciplinary action.

2. Masking the records

To avoid the risk that other staff or family members might see the information, you might be tempted to mask a record (by using a false name), or not to include sensitive information in the medical record.

For example, you might choose to exclude information about HIV status or illicit drug use to protect your patient’s privacy.

This would mean the medical record was not accurate and complete, making it difficult for another doctor to treat the patient in your absence.

3. Potential conflict of interest

Work commitments might influence your clinical decision-making when you treat staff or colleagues.

You might gain knowledge about a staff member or colleague’s medical condition because they are a patient, but you cannot use that knowledge for employment issues such as fitness for work. This can put you in a difficult position.

You might be asked to write a worker’s compensation certificate arising from an injury at work.

This potentially creates a conflict between you as a practice owner/doctor and you as a treating practitioner.

We strongly recommend you do not provide a worker’s compensation certificate for a staff member or colleague at the practice.

Your knowledge of a staff member’s medical history or personal circumstances may impact upon your treatment of them as an employee. You may expect less of a staff member or grant them more leeway based on their illness.

This could lead to complaints of unfair treatment from other workers if they are unaware of the situation.

4. Informal provision of healthcare

You may be more inclined to engage in “corridor consultations” with staff and colleagues if you are in a treating relationship with them.

A busy receptionist might ask you to write a script for painkillers rather than making a formal appointment or may ask you to write a pathology request for a sick child.

You may forget to write a note about your treatment decision in the patient’s medical record, which can have consequences later on.

5. Prescription theft or forgery

We often advise practices about the risk of staff forging scripts and medical certificates. This could happen whether the staff member is a patient or not, but it is easier if they are already in the system.

What can you do to protect yourself from risks?

The simplest answer is to not treat staff, practice colleagues and their families, if you can avoid it.

If you do choose to treat staff, practice colleagues and their families:

  • Discuss the issue with new staff and set boundaries and expectations;
  • Ensure you have appropriate systems in place to guard against privacy breaches;
  • Ensure medical records are complete and up to date;
  • Avoid engaging in “corridor consultations” — ensure appropriate time is set aside for you to make considered clinical decisions; and
  • Be conscious of whether you are speaking with the staff member as their employer or their treating practitioner.

This article was previously published in AusDoc.Plus on 11 September, 2018.

More information

For more on this topic, read section 3.14 on personal relationships in the Medical Board of Australia ’s Good medical practice: A code of conduct for doctors in Australia.

For more medico-legal information and support, visit our website or email our Medico-legal Advisory Service (MLAS) at: nca@avant.org.au or call 1800 128 268 for expert advice, 24/7 in emergencies.

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