VICTORIA, AUSTRALIA
NEW DRAFT STATEMENT: DOCTORS TREATING THEIR FAMILIES
The board is currently developing a statement on doctors treating their families. To support debate, we publish below this draft statement and invite comment from the profession and the community. Submissions on the draft statement can be emailed to Dr. Joanne Katsoris at: [email protected] or posted to her at GPO Box 773H, Melbourne, VIC, 3001. The draft policy is published on the board’s website (http://medicalboardvic.org.au).
Doctors’ ethical responsibilities – to themselves and to their families
This draft statement outlines proposed guidelines for the provision of medical care by doctors to themselves and their families.
All doctors should have a general practitioner.
The responsibility for overall care and continuity of care of a doctor and each member of their family should rest with their general practitioner. Referral for specialist consultation, care, or advice should be made through their general practitioner.
A doctor’s general practitioner should not be a relative nor, unless there is no practical alternative, another member of the doctor’s practice.
Doctors need to be aware that they become the patient in the doctor patient relationship when receiving medical care.
It is not appropriate for a doctor to assume responsibility for the diagnosis and management of his or her own health problems or those of their partner and immediate family, except in the most unusual circumstances (such as an emergency or when there is inability to access medical care). In such cases, ongoing care should be the responsibility of their general practitioner who should be informed about the action taken by the doctor.
Doctors should not damage the confidence that their relatives have in their own general practitioner by undermining the advice and treatment that they have been given.
Doctors must not prescribe for themselves.
If a doctor writes a prescription for medication for a family member, it should be in consultation with their general practitioner and except in unusual circumstances, should only be for continuation of medication prescribed by their treating practitioner. A doctor should never prescribe a Schedule 8 drug for a family member or partner except in a serious emergency, when it should be on a one-off basis only.
Doctors have an ethical duty, to themselves and to their patients, to ensure that their own health problems are effectively managed, that they seek competent professional advice on their health and particularly on their ability to work, and that they follow that advice.
Doctors should not take advantage of the access they may have to medical records to look at the records of their family and friends without their consent.
The board acknowledges the Guidelines provided by the British Medical Association Ethics Committee on Ethical Responsibilities of doctors towards themselves and their families, from which these guidelines are substantially drawn.
MORE ON PRESCRIBING…
The Pharmacy Board of Victoria recently asked the Medical Practitioners Board of Victoria to remind medical practitioners of some of their obligations when prescribing medications. The request came after hearing concerns from pharmacists unable to contact prescribing practitioners to verify the authenticity of suspicious-looking prescriptions. The medical practitioners had not completed their contact details.
As professionals, medical practitioners and pharmacists need to work cooperatively in the shared aim of optimal patient care. A positive relationship between the two professions, based on mutual understanding, good communication, and respect, can benefit the doctor, the pharmacist, and the patient.
Pharmacists are well within their legal rights to refuse to dispense medication when the documentation on the prescription is deficient.
Regulation 23 of the Drugs, Poisons and Controlled Substances Regulations 1995 defines some of the legal obligations of medical practitioners when writing prescriptions. Important obligations include:
Prescriptions for Schedule 4 or 8 poisons must be in the practitioner’s handwriting or in a manner approved by the Chief General Manager of the Department of Human Services, such as computer generated prescriptions which must include handwritten details for ALL drugs of dependence – not just Schedule 8 poisons.
Medical practitioners must write prescriptions for Schedule 4 or 8 poisons, legibly and durably and include:
the name, address, and telephone number of the prescriber
the name and address of the patient for whom the prescription is intended
the date on which the prescription was written
the handwritten signature of the prescriber
full particulars of the poison or controlled substance to be supplied, including a statement of the quantity to be supplied
in the case of a Schedule 8 poison, a statement of the quantity to be supplied written in words and figures
directions for the precise dose or use and frequency of administration except in cases where
because of the complexity of the dosage regimen or use it is impracticable to do so and the prescriber has separately supplied the patient with written instruction, or
the administration of the substance is to be carried out by a medical practitioner, pharmacist, dentist, authorized optometrist, or nurse
the maximum number of times the prescription may be supplied if more than once, and
in the case of a Schedule 8 poison, the maximum number of times the prescription may be supplied, written in words and figures.
Problems can arise when practitioners do not follow the regulations. Any resultant compromise to patient safety is unacceptable and likely to be regarded as unprofessional conduct.
Other issues related to prescribing and dispensing
Medical practitioners need to be aware that pharmacists may decline to dispense prescriptions that are presented more frequently than would be reasonably necessary if taken in accordance with the stated directions. It is therefore essential that the stated directions are an accurate reflection of the intended rate of administration.
Medical practitioners also should be aware that Regulation 25 makes it an offence to knowingly include on a prescription any particular that is false or misleading. This could apply to deliberately understating directions for use and/or post-dating prescriptions.
If you have questions about your prescribing obligations, contact the Drugs and Poisons Unit of the Department of Human Service on 1300 364 545.
Reprinted from the Medical Practitioners Board of Victoria Bulletin, Vol. 3, August 2003
ALBERTA, CANADA
PHYSICIANS AND CIVIL LITIGATION
The Alberta Information and Privacy Commissioner has recently completed an investigation into the discovery of patient health information on the hard drive of a computer. The Commissioner offered some recommendations regarding the security of computer data storage of value to physicians.
The circumstances were that a transcriptionist’s computer locked up and stopped working. She was unable to access or delete files. She had used her computer to transcribe office medical notes and letters of referral.
The transcriptionist took her faulty computer to the store where it was purchased and received a new one. She understood that computers with a hard drive problem could be returned to the manufacturer and that the hard drive would be destroyed.
Unfortunately, the hard drive was not destroyed; rather, the computer was sold to a salvage company and then re-sold. The unidentified purchaser found personal health information on the hard drive. A floppy disk containing this information was provided to the media.
While the Information and Privacy Commissioner found that the medical clinic in question had policies and procedures in place regarding maintaining the privacy and security of patient information, he found that the custodians did not foresee the risk of unauthorized access to this information, and offered the view that custodians may not be aware of the proper method of disposal of a computer that contains health information.
The Commissioner made the following recommendations:
Custodians should assess their administrative, technical and physical safeguards protecting health information and he specifically recommended that computer data storage components (e.g. computer hard drive, tapes, diskettes) be destroyed, or that the stored health information on these components be permanently deleted through use of a commercial disk wiping utility.
Custodians should ensure that their affiliates be aware of and adhere to these safeguards, and that agreements between custodians and affiliates contain provisions to ensure compliance with the HIA and with the custodian’s policies and procedures, including specific direction as to the storage and disposal of health information during the time of the agreement, and at termination of the agreement.
Custodians should review all policies and procedures and update them to comply with the HIA. The message, in brief, is that information on a computer hard drive must be protected as must all health information. When getting rid of an old or defective computer, it is the custodian’s responsibility to ensure that the hard drive is destroyed or that the information on the hard drive has been permanently deleted through use of a commercial disk wiping utility. The full Commissioner’s report can be accessed on the OIPC website at www.oipc.ab.ca/ims/client/upload/H2003IR002.pdf.
Reprinted from the Septrember 2003 issue of The Messenger, published by the College of Physicians and Surgeons of Alberta.
PHYSICIANS AND CIVIL LITIGATION
The Alberta Court of Appeal recently issued a decision that addresses issues surrounding the interview of a treating physician in a civil litigation case.
The case involved a plaintiff suing the defendant for personal injuries that resulted from a motor vehicle accident. Shortly before trial, the defendant’s lawyer wanted to interview the plaintiff’s treating physician. The plaintiff agreed to the interview, but imposed the condition that the plaintiff’s lawyer would also be present during the interview. The defendant would not accept this condition and brought the issue before the court.
The Court of Appeal decided that the plaintiff has the right to insist on his or her lawyer being present during an interview of the plaintiff’s treating physician by the defendant or his or her lawyer. The Court of Appeal also found no distinction between a treating physician and one who had been retained as an expert to provide an opinion in the lawsuit, recognizing that often a physician may wear both hats.
Even though a patient consents to his or her doctor being interviewed by another party, the physician can decline to do so. The physician cannot decline, however, to testify in court if served with a subpoena or a notice to attend. There is always the practical consideration that agreeing to an informal interview may avoid the need to be called as a witness at trial.
Accordingly, any physician who receives a request to be interviewed by a third party should advise his or her patient that the patient has the right to insist on his or her lawyer being present during that interview, if the physician agrees to grant the interview. The presence of the patient’s lawyer adds an additional safeguard to ensure only relevant questions are asked and answered and that the interview does not become a “fishing expedition.”
Reprinted from the College of Physicians and Surgeons of Alberta website.
MANITOBA, CANADA
RELEASE OF INFORMATION TO NONCUSTODIAL PARENTS
Members frequently call the College for advice on releasing health care information to a non-custodial parent.
The legal right of a non-custodial parent to such information is set out in s. 39(4) of The Family Maintenance Act, which states: “Unless a court otherwise orders, the non-custodial parent retains the same right as a parent granted custody to receive school, medical, psychological, dental and other reports affecting the child.” In other words, unless there is a court order restricting access, the non-custodial parent has just as much right as the custodial parent to access the child’s medical records.
Physicians are cautioned that there may be a court order restricting a non-custodial parent’s access to a child’s medical information. Physicians are responsible to make inquiries in that regard. If any uncertainty remains, the physician is advised to obtain legal advice.
The right to information should not be confused with a right to make health care decisions. Section 39(5) of The Family Maintenance Act makes clear that the right to information guaranteed in section 39(4) does not give the non-custodial parent any right to be consulted about or participate in the making of decisions for the child by the custodial parent.
The Personal Health Information Act recognizes the right of a parent to access his or her child’s medical information if that child has not acquired the capacity to make his/her own health care decisions. Before releasing personal health information about a child to a custodial or non-custodial parent, physicians must assess whether the child has the capacity to make his or her own health care decisions. If so, the physician should seek the child’s consent before releasing any personal health information about the child.
Reprinted from the College of Physicians and Surgeons of Manitoba website
ONTARIO, CANADA
SETTING THE RECORD STRAIGHT ON INTERNET PRESCRIBING
Lately, College staff members have noticed a number of advertisements that suggest Ontario doctors can write prescriptions based on information provided by U.S. individuals through the Internet. Since the prices of many pharmaceuticals in Canada are much lower than the prices in the United States, there is considerable demand from American patients to purchase Canadian drugs.
Many of the advertisements suggest or state that Ontario physicians can co-sign or authorize an American prescription to be dispensed in Canada. Some require the patient to submit medical information by means of a questionnaire. Some of these advertisements go so far as to state that such arrangements are consistent with the policy of our College.
So that no doctor will be deceived or confused by these statements, it may be wise to briefly review the College policy, Prescribing Outside an Established Physician-Patient Relationship (#8-00).
If a physician wishes to sign or co-sign a prescription for an individual who is not his/her patient, basic medical principles of assessment and diagnosis must be applied. It is incumbent upon the physician to obtain an adequate history and perform an appropriate physical examination to reach a diagnosis that will ensure that the requested medications are appropriate. The physician is advised to fully document the encounter.
It is not acceptable for a physician to sign or co-sign a prescription without attending the patient.
Even in cases where this service is provided appropriately, physicians are urged to exercise due caution, existing diagnostic information about the patient may not be available to the physician providing the service. Furthermore, if there is an adverse outcome for these patients, physicians may not be legally protected from a lawsuit. Physicians in these circumstances may not be covered by existing Canadian professional liability insurance and are advised to contact the Canadian Medical Protective Association.
Physicians in any doubt about proposals made to them relating to cross-border prescribing or dispensing of medications may wish to consult with the Physician Advisory Service here at the College. As always, the Service will answer any questions and provide any help possible.
Reprinted from the College of Physicians and Surgeons of Ontario website
