Why treating staff members can be problematic
Elizabeth Quinn, BA, LLB, GDipLegalPrac, Senior Associate, Professional Conduct, Avant Law
Thursday, 15 February 2024
Doctors are reminded to avoid treating colleagues after a GP faced an Ahpra complaint from a staff member who had been provided with medical care.
A staff member at the practice booked an appointment with the doctor while at work, complaining of chest pain. The doctor agreed to see him in case emergency care was required.
The doctor took a medical history, conducted an examination and reviewed the staff member’s ECG, which was normal. After documenting the consultation, the doctor advised him to follow-up with his regular GP.
A few days later, the doctor called the staff member to provide him with his blood test results. The doctor advised that if his symptoms didn’t improve in three weeks, then a referral to a cardiologist should be considered. The doctor also reiterated the need for the staff member to attend with his regular GP for any future care.
Staff member books further appointments
The staff member booked another appointment with the doctor regarding his ongoing chest pain. The staff member said he was unable to see his regular GP that week.
The doctor saw the staff member and arranged for him to see a cardiologist the next day. The cardiologist advised the pain was unlikely cardiac, possibly muscular in nature, and recommended simple analgesia.
The doctor discussed the results of the investigations with the staff member and provided him with a copy of the results. The plan was for any further follow up to be with the regular GP.
Instead of seeing his regular GP, the staff member made appointments to see another GP at the practice, again insisting that the care was urgently required and could not be provided by his regular GP. The practice eventually had to advise the staff member they were unable to book further appointments and offered to transfer records to his regular GP.
The staff member resigned and then submitted a complaint to Ahpra expressing concern that the doctor had inappropriately influenced the decision of the practice not to provide further appointments. The complaint also aired workplace grievances and alleged bullying conduct and privacy breaches.
Defending the doctor
We assisted the doctor to prepare a response to Ahpra. We were able to explain the doctor’s actions with reference to the Medical Board of Australia’s Code of Conduct and the practice’s policy on treating staff and their families, which incorporated the guidance from the Code of Conduct.
The Code of Conduct says: “In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient.”
However, the guidelines provide that in situations where doctors are providing care to those close to them and it is unavoidable, good medical practice requires recognition and careful management of these issues.
The practice’s policy followed the Code of Conduct, including stipulating that doctors should avoid treating practice staff and their families as far as possible, except in emergencies.
In this case, the Medical Board of Australia decided to take no further action.
Why doctors should avoid treating staff
Treating a staff member can be driven by an intrinsic desire to help or pressure from the employee to be treated. However, there are many reasons why providing care to staff can be inappropriate.
Lack of objectivity
Maintaining objectivity in this situation can be challenging. A doctor may find it awkward to and/or refrain from asking sensitive questions, or the patient might find it difficult to disclose sensitive information to you, so you may miss vital information.
Taking and/or providing a complete history or full physical examination may be uncomfortable for the doctor or the patient and may lead to the doctor not completing a full assessment.
What a doctor knows about the staff member outside of the consultation room may also influence their management.
A lack of objectivity may also mean a doctor does not follow-up on appropriate investigations or referrals, which can result in a missed diagnosis.
Discontinuity of care
A lack of continuity of care can also arise, particularly if a staff member persuades a doctor to provide a repeat script or referral or perform a ‘corridor consultation.’
In these situations, documentation may be informal or non-existent, and there may be no proper handover or follow up, which can compromise patient care.
Other staff may be able to access the medical record of a colleague or their family. Without a clinical need to do so, this may be a privacy breach and would be exacerbated if this information is discussed with other people.
Complete and accurate records
A doctor might be tempted to mask a record (for example, by using a false name), or exclude sensitive information, (for example, information about a mental health issue) to protect their colleague’s privacy.
Conflict of interest
Where a doctor is also the employer or manager, a conflict of interest is likely to arise. Your knowledge of the medical history or personal circumstances may impact their management of the employer-employee relationship and could lead to concerns, for example, about discrimination.
If a working relationship breaks down, this could also compromise the treating relationship.
It is generally recognised that it’s in a patient’s best interests to obtain their medical care outside of their workplace.
Tips when it’s necessary to treat a colleague
As a doctor, if you find yourself in an emergency situation, or an isolated setting where you do need to provide treatment to a colleague, keep these tips in mind:
- Ensure consultations occur in a proper setting and they are thorough.
- Set boundaries and expectations about the treatment you will provide.
- Have appropriate systems in place to protect against privacy breaches.
- Where treatment is provided in an emergency, hand over care to another doctor once the emergency has been dealt with.
- Ensure appropriate medical records are made of the treatment provided.
The case discussed in this article is based on a real case. Certain information has been de-identified to preserve privacy and confidentiality.
IMPORTANT: This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published.