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A Doctor in the House: Ethical and Practical Issues when Doctors Treat Themselves and Those they are Close to

Asian Bioethics Review volume 10, pages 3–19 (2018)Cite this article

Abstract

Having a doctor in the family is often seen as beneficial as there is easy access to medical advice and care. It is common for doctors to treat themselves and those they are close to, and some doctors consider this their prerogative. However, there are pitfalls. Primarily, there is a risk of compromising clinical judgement and objectivity when doctors self-treat and treat those they have a close relationship with. This could lead to treating problems beyond the doctor’s competence—in some instances, because someone close pressures the doctor. Other pitfalls include trivialising or overtreating a condition, failing to document the care provided, making assumptions about a person’s circumstances, and breaching confidentiality. Consequently, despite good intentions, a doctor may not provide the best quality care to those they are close to. This paper examines the ethical and practical issues that arise when doctors treat themselves and those they have a close relationship with. It argues that in the vast majority of clinical situations, doctors should not engage in such care arrangements, and explains why doctors should have their own regular doctor. Several cases where doctors in New Zealand have been censured for self-treatment will be discussed. The paper compares New Zealand’s position with Singapore’s and explores several factors that contributed to the different positions that were adopted. The paper concludes that this is a fraught area of care so it is important that medical regulators set standards that promote best practice and that provide clear guidance to the profession and public.

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Notes

  1. In addition to the NZ medical profession itself, other stakeholders include specialist medical colleges (such as the Royal Australasian College of Physicians and the Royal Australasian College of Surgeons), NZ Government bodies (such as the Ministry of Health and the Office of the Health and Disability Commissioner), and the Consumer Advisory Panel.

  2. Clause 1 of the MCNZ statement defines minor conditions as “a non-urgent, non-serious condition that requires only short-term, episodic, routine care, and is not likely to be an indication of, or lead to, a more serious, complex or chronic condition, or to a condition that requires ongoing clinical care and monitoring”. The MCNZ statement also clarifies that “complex or chronic conditions are not considered minor conditions even where their management may be episodic in nature.” MCNZ’s definition is based on how CPSO defines minor conditions in its policy statement although MCNZ’s definition omits any examples of minor conditions.

  3. The names of the doctors involved and those they treated have been removed to protect their privacy. Identifying letters that have been assigned bear no relationship to the person’s actual name.

  4. MCNZ is not a disciplinary body, although it manages some complaints to do with professional conduct, competence, and health concerns about the doctor. All patient complaints in NZ are directed initially to the Office of the Health and Disability Commissioner which is an independent government body tasked with promoting and protecting the rights of patients and facilitating the fair, simple, speedy, and efficient resolution of health and disability complaints.

  5. A repeat prescription is given at the doctor’s discretion where the patient’s condition is stable and if the patient has seen the doctor within the last 6 to 12 months. A repeat prescription enables the patient to return to the pharmacy for a further supply of the same medication without having to consult the doctor. In the case of Dr X, two repeats for duromine and triazolam meant that an additional 30 duromine tablets and 30 triazolam tablets would have been dispensed on two subsequent occasions if the pharmacist was satisfied that the prescription was appropriate.

  6. It would have been preferable if guideline B1 point (5) was cross-referenced to guideline A3 point (1) of the 2016 ECEG which requires doctors in Singapore to practise within the limits of their competence. Guideline A3 point (1) also prohibits doctors in Singapore from engaging in unsupervised practices where they do not have the requisite skills, knowledge and experience (Singapore Medical Council 2016a).

  7. Section B1.2 of the 2016 HME expands on guideline B1 point (5) of the 2016 ECEG by highlighting the inherent risks involved when doctors treat themselves and those they are close to (Singapore Medical Council 2016b). The 2002 ECEG contained no guidance on this topic.

  8. The Consumer Advisory Panel is a 12-member panel representing a cross-section of consumers who use NZ’s health and disability support services such as Māori, Pacific Island, the elderly population, mental health patients, those with disabilities and chronic conditions, and the migrant community. Established in 2003, the panel provides advice to MCNZ from a consumer’s perspective on strategic and operational health and disability issues.

Abbreviations

CPSO:

College of Physicians and Surgeons of Ontario (Canada)

GMC:

General Medical Council (United Kingdom)

GP:

General Practitioner

HPCAA:

Health Practitioners Competence Assurance Act 2003 (New Zealand)

MBA:

Medical Board of Australia

MCNZ:

Medical Council of New Zealand

SMC:

Singapore Medical Council

2016 EGEG:

Singapore Medical Council’s 2016 Ethical Code and Ethical Guidelines

2016 HME:

Singapore Medical Council’s 2016 Handbook on Medical Ethics

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Acknowledgements

I would like to acknowledge Dr Steven Lillis and Dr Kevin Morris who provided helpful feedback on earlier versions of this paper. A special thank-you to Philip Pigou for his guidance and support. Most of all, I thank the Lord who restores and renews and who makes everything beautiful in His time (Ecclesiastes 3:11).

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Authors and Affiliations

  1. Medical Council of New Zealand, PO Box 10509, The Terrace, Wellington Central, 6143, New Zealand

    Kanny Ooi

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  1. Kanny Ooi
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Correspondence to Kanny Ooi.

Ethics declarations

Conflict of interest

I am a Senior Policy Adviser and Researcher at the Medical Council of New Zealand. Over 2016, I was primarily responsible for reviewing MCNZ’s statement for doctors on Providing care to yourself and those close to you. This included conducting stakeholder consultations, reviewing written submissions from doctors and the public, facilitating focus group discussions with the Consumer Advisory Panel, and writing policy papers for MCNZ’s governing Council.

I previously worked for the Singapore Medical Council and was involved in the initial review of its revised Ethical Code and Ethical Guidelines. My views about SMC and its guidelines are purely personal and do not reflect or represent the collective views of MCNZ in any way.

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Ooi, K. A Doctor in the House: Ethical and Practical Issues when Doctors Treat Themselves and Those they are Close to. ABR 10, 3–19 (2018). https://doi.org/10.1007/s41649-018-0043-2

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  • DOI: https://doi.org/10.1007/s41649-018-0043-2

Keywords

  • Doctors
  • Self-treatment
  • Family
  • Close relationships
  • Patient safety
  • Medical regulation
  • Medical Council of New Zealand
  • Singapore Medical Council