The pitfalls of self-prescribing

Dr Ian Lavelle, Medico-legal Consultant at Medical Protection, discusses the issue of doctors treating or prescribing for themselves.

Most clinicians are aware that their judgement could be clouded when self-diagnosing or self-treating. Due to the nature of self-prescribing one may assume that it may go unnoticed by the Medical Council, when in fact the opposite is true. The regulator may scrutinise a doctor following a pharmacy complaint, for example, or following a Pharmaceutical Society of Ireland (PSI) investigation of a pharmacy’s practices. 

A memorandum of understanding between the PSI and the Medical Council, sets out that one can report concerns to the other to investigate in the interests of public safety: “Both parties agree to make complaints, where necessary or as and when required, to one another regarding breaches of the Pharmacy Act 2007 and the Medical Practitioners Act 2007, made by registered medical practitioners, registered pharmacists and/ or registered retail pharmacy businesses (pharmacy owners) in the interest of patient safety and public protection.” 

In such cases, the PSI themselves will often become the complainant to the Medical Council. Medical Protection is also aware of cases where a pharmacist has raised concerns with the Medical Council about a doctor’s self-prescribing. Most commonly this occurs with the prescription of controlled drugs, benzodiazepines, and antidepressant medication. 

Ethical guidance 

The Medical Council provides ethical guidance in relation to self-prescribing and self-treating. This clearly states that doctors should not act as their own treating or prescribing doctor and outlines a doctor’s ethical responsibility as follows: 

“58.1 You have an ethical responsibility to look after your own health and wellbeing. You should not treat or prescribe for yourself. You should have your own general practitioner, who is not a member of your family and you should be vaccinated against common communicable diseases. 

“58.2 If you have an illness which could be a risk to patients or which could seriously impair your judgement, you must consult an appropriately-qualified professional and follow their advice. This professional will have a dual role: To help and counsel you and to make sure you do not pose a risk to patients and others. If such a risk exists, you must inform the Medical Council as soon as possible.” 

All doctors should be aware that if they self-prescribe they are at risk of a complaint to the Medical Council and sanctions against them 

If the Medical Council is made aware of a doctor who is self-prescribing, the regulator will look at all the available facts in a particular case. Regardless of whether the Medical Council ultimately takes action or not, it still causes enormous stress for the doctor.

Survey 

A recent survey of NCHDs (https://jme. bmj.com/content/46/4/231) identified widespread practice of self-prescribing and also prescribing for family members and friends. In this survey, two-thirds of respondents had self-prescribed. Of those who had self-prescribed, between three and seven per cent had prescribed a controlled drug or psychotropic medication. Some prevalent risk factors for self-prescribing were suggested, which included work-life imbalance and burnout, lack of support, and intensely busy and under-resourced workplaces. In addition, doctors rarely take sick leave for fear of increasing the workload of already strained colleagues. As a result, they may self-prescribe to hasten their recovery. However, it is possible that the wish to fulfill one’s duties could lead to a neglect of one’s own wellbeing. Thus, doctors who feel unwell and require treatment should consult another doctor, who is not someone from their family. 

The RCPI stated the following in relation to the survey: 

“The RCPI believe doctors have a responsibility to themselves, their families, their patients, and the healthcare system to take care of their own health. We advise doctors to monitor their physical and emotional wellbeing and to seek assistance early if they have any concerns or feel they are experiencing significant stress…. [W]e encourage doctors to provide support and assistance to colleagues in a confidential, sensitive, and professional manner. This means reiterating the importance of the GP role, ensuring it is not bypassed, and discouraging the casual or ‘corridor consultation’.” 

Whether self-prescribing results from simple convenience, a lack of objectivity or denial, it may present risks to both the doctor’s health as well as that of their patients. All doctors should be aware that if they self-prescribe they are at risk of a complaint to the Medical Council and sanctions against them. 

The Medical Council’s ethical guidance is due to be updated and it is possible that there may be further strengthening of their existing guidance. 

More medico-legal dilemmas will be discussed at Medical Protection’s Medical Conference on Saturday 26 November 2022 at 9.45am-4.30pm, Convention Centre Dublin. For more information, visit medicalprotection.org/ ireland/resources-training/events.