Guidance

Recently while lying in bed half-awake coughing up a lot of green sputum, I reflected on the fact that GMC guidance now prevents us prescribing for ourselves or our family. Of course I understand the rationale behind the change: we are not as objective when considering ourselves and our families as when considering others, and there have been problems with doctors abusing self-prescribed drugs. But emotionally it feels different. I have been allowed to prescribe for myself and family since I qualified over thirty years ago. Now I am no longer trusted to do so sensibly. It is the lack of trust which hurts, rather than the minor inconvenience.

The GMC have just emailed me with details of their revised guidance in other areas. They call this "supporting you in challenging situations" which sounds wonderful. Unfortunately, when you look closely they are not quite as supportive as they claim. On the subject of having a personal relationship with a former patient they say that a certain amount of time must elapse between the professional relationship ending and the personal relationship beginning. Fair enough, but how much time? "It is not possible to specify a length of time after which it would be acceptable to begin a relationship with a former patient." To my mind, that does not constitute supportive guidance. If a doctor finds himself in front of a disciplinary hearing he won't have a leg to stand on, and the panel can reach whatever decision they feel like. It is likely to be harsh, "pour encourager les autres".

On the subject of doctors using social media they say "if you identify yourself as a doctor in publicly accessible social media you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely". In my case I have identified myself by name, but it is a pseudonym and identified as such. The reason is to help protect the confidentiality of my patients. Details of consultations are obscured in various ways; I hope my anonymity will also help. But I write as a doctor observing the principles of my profession. Or at least, the principles I started out with. (If you don't like them, I have others.)