"Going That Extra Mile" For Patients Can Backfire, Warns MDDUS, UK

Main Category: Litigation / Medical Malpractice
Article Date: 19 Jan 2009 - 8:00 PDT

email to a friend   printer friendly   opinions  

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

• Additional
• References
• Citations