GPs can be "too helpful" to patients and blind to the risks of getting too
closely involved in matters that are not strictly clinical, according to an
article in the latest (Winter 2009) edition of Summons, the magazine of
MDDUS, The Medical and Dental Defence Union of Scotland.
"Going that extra mile" for patients can backfire and cause more trouble for
a doctor than they imagine, warns Dr Jim Rodger, who is a medico-legal
adviser and head of professional services at the MDDUS. He advises a
"healthy emotional disengagement".
Examples of "extra milers" include doctors who:
- Go to "extraordinary lengths" to refer patients, such as
hand-delivering letters after work or driving patients to appointments.
- Take great pains to prescribe "weird and wonderful" medicines that
patients have read about or seen on the internet.
- Give in, against all legal and ethical advice, to patients'
demands for banned medicines (e.g. Coproxamol).
It is not uncommon for patients to ask GPs to refer them to "specialists",
says Dr Rodger. One MDDUS client recently spent hours researching the
qualifications and registration of an "expert". "He was absolutely right to
check, but it proved a lengthy, time-consuming project."
GPs develop close relationships with patients both clinically and socially.
They get caught up particularly in the lives of patients with serious or
long-term illnesses. But compassion for patients in difficulties may blind a
doctor to the risks of involvement "beyond healthcare".
"Avoid giving help and advice to families in relation to such matters as
powers of attorney, capacity or incapacity, or the validity of wills," warns
Dr Rodger. "Becoming too closely involved in such matters risks legal
proceedings, or getting embroiled in family disputes."
MDDUS has advised GPs who, because of their concern for patients or their
surviving carers, have thought to intervene in insurance claims. But
insurance reports must be factually accurate and supplied to an insurance
company irrespective of their effects on the family.
Custody battles are another potential source of grief for GPs, who may be
pressured to take sides or asked to intervene on one side or another.
Getting too closely involved is dangerous, and has little, if anything, to
do with clinical concerns. Parents must be directed to the right
professional to resolve matters - a lawyer.
The MDDUS has also advised doctors who have become embroiled in
correspondence with a patient's employer about suitability or otherwise for
work, or in relation to work-related illness. "Unless you have expertise in
occupational medicine, tread very carefully," urges Dr Rodger.
Getting drawn too far into a patient's life "beyond the surgery" can raise
questions of competence - advising on how to tackle debt problems may be
tempting but can result in a complaint if things go wrong. Doctors also risk
harm to their own emotional and mental health.
"Burnout and compassion fatigue are real issues for GPs," says Dr Rodger.
"Extra-curricular activities can take their toll. GPs are well suited to
having a holistic view of patients' physical, social and psychological
issues. But some patients present with a seemingly irresolvable tangle of
interrelated problems. Trying to 'take on' such patients can be exhausting
and thankless. Often the best a doctor can hope for is to manage problems
and conditions as they arise."
MDDUS is a medical defence organisation providing access to professional
indemnity and expert medicolegal advice for doctors, dentists and other
healthcare professionals throughout the UK.
MDDUS