Medico legal Dilemmas: some commonly faced medicolegal situations in healthcare professional work situations especially in the early days of career.

 

 

Can I accept gifts from patients?

 

For many patients an episode of illness is a major life event and they will want to express their appreciation to doctors and allied health staff. This can take the form of simple gifts such as chocolates or a bottle of wine. Others will bake a cake or bring produce from their garden to the consultation. In some cultures this is a routine component of health care. These are genuine gestures of thanks and it is likely to cause offence if a token gift is not accepted in the manner it was offered.

 

However, some gifts are excessive and not in keeping with the doctor patient relationship. You should consider carefully before you accept gifts of significant magnitude. It is possible that some patients will feel an expensive gift provides them with greater access to your services. A polite but firm refusal indicating that you have been financially remunerated for your services is appropriate. This will maintain a balance in your relationship and not leave you beholden in future interactions.

 

My patient is a tradesman and has offered to provide his services at a cost price. Can I accept? 

 

Offers of this nature may be a genuine expression of appreciation. Nevertheless everybody is entitled to be paid adequately for services rendered. A discount may be appropriate; however care should be taken not to exploit the good will of patients.

 

I have been invited to dinner at a patient's home should I accept?

 

As a general rule it is not appropriate to develop your social network through your patients. The closer your friendship with any individual the less objective you are likely to be in a clinical situation. However, from time to time and particularly in small communities it is inevitable that you will mix socially with people who you may treat. On these occasions it may be relevant to indicate that you are 'off duty' to avoid the conversation drifting into an informal consultation. It is important that strict confidentiality is maintained, as some people may not want to be acknowledged as your patient.

 

Should I invite patients to my home socially?

 

If your only connection with the patient is through your clinical work it is inappropriate to involve them in your private social life. This blurs the professional boundaries and in many instances is not a comfortable role for the patients.

 

Can I have an intimate/romantic relationship with a patient?

 

You should be familiar with your Medical Board's policy relating to sexual misconduct. Patients trust a doctor with their most intimate information. Moving from a clinical role into a sexual relationship is regarded as unequal and an imbalance of power. Patient complaints following the breakdown of a relationship with their doctor always describe their feelings of exploitation. In the event of a complaint the Board will consider the nature, duration and time since termination of the original doctor/patient relationship.

 

If you wish to become involved with some one you have treated in the past contact our advice line for guidance relating to documentation and future treatment of the patient. It is not acceptable to contemplate commencing a relationship with an existing patient.

 

Should I treat family and friends?

 

No. Only in exceptional circumstances when other services are not available should you become the treating doctor for those close to you. Your judgment can be distorted by your knowledge of the patient. It is unlikely that you will assume an adequate doctor/patient relationship. Consultations of this nature tend to be informal and without appropriate documentation.

 

Should I provide volunteer medical services for my sporting team? 

 

As a JMO you are not covered to work independently and therefore not qualified to offer your services as a volunteer. You are covered for Good Samaritan acts. This is where you assist in an emergency generally where you do not know the patient. Regular attendance as the doctor at your teams sporting events and assisting if there is an incident does not constitute a good samaritan act.

 

Is it a problem if I write a repeat prescription for friends who are being treated by another doctor?

 

To do this breaks the continuity of care between the patient and their treating doctors. In addition no records are kept on the patient's file documenting the additional medication. Unless there are extenuating circumstances these is not good medical practice. If you get a reputation for being prepared to write prescriptions for friends you may find that you will become the second treating doctor by default. This can present a significant risk to you and the patient, as you will not have access to all of the patient's history.

 

Should I warn friends about colleagues who are not held in high esteem by the profession?

 

Colleague's opinions of their peer's professional reputations are often no more that personality polls. To repeat personal views as fact is dangerous and may leave you open to be challenged in court. All patients are entitled to a second opinion and if you feel there may be a better clinician for your friends you should advise them in this context.

 

Is it my responsibility to act on any concerns about colleague's health status or should that be left to senior staff to handle?

 

As a JMO it is always difficult if you are concerned about a senior colleague’s health or competence. However if your concerns are genuine it is important that these are raised. Doctors are not always good at monitoring their colleague’s health status and changes may not have been picked up by others. The best approach may be through your supervisor and Director of Clinical Training. You can take this step in the knowledge that either the hospital or Medical Board will have a system in place for assisting in the treatment and rehabilitation of sick doctors.

 

 

Medico-Legal Tips for junior doctors

 

 

 

We will be regularly updating these tips with new medico-legal information, so check back in the future to see what has changed.

1.                 Seek advice – remember that you are in a training position and entitled to obtain assistance. If you are uncertain about what to do in a particular clinical situation or you are uncomfortable about performing a particular procedure - no matter how small - discuss it with your registrar or consultant.

2.                 Communication, both written and oral, is the cornerstone of good medical practice. Communication failures in the chain of care are the most common cause of preventable patient disability or death, and are nearly twice as common as problems due to inadequate medical skills.

3.                 Make legible, concise and contemporaneous notes. The primary purpose of the medical records is to allow another practitioner to continue the management of the patient. The records are also your best defence in the event of a complaint or claim. Good medical record keeping is an important clinical skill. Bullet point documentation will suffice.

4.                 If you receive a request for a medico-legal report, for example from the police or the Coroner, always seek advice from risk management company before providing the information. It is essential that you maintain your duty of confidentiality to the patient even though they are deceased.

5.               If you do receive a complaint, you are not alone. It has been estimated that about one in twenty doctors receive a formal complaint every year.

 

(obtained from MDA website)