Dr Rachel Birch, Medico-legal Consultant at Medical Protection, discusses the complexities in treating high-profile patients and provides some advice.
When a high-profile patient dies, the circumstances around their death and sometimes their relationship with their doctor can be thrown into the media spotlight. This may be a daunting prospect for doctors. Although very few doctors will face such an extreme situation, it is useful to be aware of some of the potential medico-legal challenges that can arise when treating someone in the public eye.
Imagine you have a patient presenting with a viral sore throat and insisting on a course of antibiotics. As well as considering whether the symptoms could be Covid-related, we know that the right thing to do usually is to advise on symptomatic treatment, and not to prescribe antibiotics without clear evidence of bacterial infection. But what would you do in a situation involving a high-profile patient – perhaps a well-known politician or sportsperson? Would you feel it safer to prescribe the antibiotics when your patient is in a position of power and used to getting what they want?
From a medico-legal point of view, of course, your medical judgement should not be swayed depending on the social status, wealth or other influence of the patient you are treating. As a doctor, you have a duty of care to all your patients regardless of whom they are. Your prime consideration should be regarding their medical condition, and what you can do in your capacity as a doctor to help.
Open up any gossip magazine and you may well find examples of celebrities’ personal health and mental health battles. For doctors, who treat these patients, dealing with issues around confidentiality is essential, although the patients may have concerns regarding their privacy. As a result, celebrities may request for details of their medical condition to be omitted from their records, or for no records to be made, in fear of it being leaked into the public domain.
The first step is to instil trust between yourself and the patient. Everyone has a right to confidentiality and high-profile patients may need extra reassurance that this right will be respected. However, it is never appropriate to intentionally leave relevant clinical information out of a medical record and this must be explained to the patient. Your duty to your patient includes ensuring that there is continuity of care, and omitting information from the record could mean other healthcare professions are misinformed about their condition and the patient is therefore put at risk.
The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Professionals (the ‘Guide’) is clear and states:
“Medical records consist of relevant information learned from or about patients…. You must keep accurate and up-to-date patient records either on paper or in electronic form…. Patients benefit when all those treating them are fully informed about their condition and medical history.”
Remember that, under the General Data Protection Regulation (GDPR), patients have the right to ensure their information is accurate and are able to request that factual inaccuracies within their record are rectified. They do not, however, have the right for a medical opinion made by you as a professional to be changed. If you need to make a correction in a medical record, make sure you enter the date of the amendment and include your name. You should only comply with a request if you are satisfied that the entry is indeed factually inaccurate, but if you decide that a correction is not warranted, you should annotate the disputed entry with the patient’s view. The Data Protection Commission provides helpful guidance on GDPR, including further detail regarding the rights of data subjects.
Even the most demanding of patients should understand that it is your professional obligation to keep a record of their care, for their wellbeing and yours. Reassure them that they can take comfort in the fact that there are laws to protect against disclosure against their
wishes, and ensure their need for confidentiality is respected.
Sometimes, despite building up a trusting doctor-patient relationship, outside influences, such as celebrities’ managers or other individuals involved in their day-to-day lives, may take it upon themselves to make decisions on behalf of their client. This can pose problems when the decisions they make are in conflict with what you believe to be in the patient’s best medical interests.
If you feel you are being pressured into a decision by a patient or third party, take time to consider your position. Ultimately, the right thing to do is to outline your concerns, the options, and tell them what the worst-case scenario would be if the patient were to refuse the advice. Except in emergency situations, you cannot enforce any treatment without the patient’s consent; equally, you shouldn’t proceed with treatment that you think is wrong merely because the patient has requested it. As with any patient, ensure you include details of all these discussions, including any refusal to treatment, in the medical notes.
You may wish to obtain the patient’s consent to discuss potential treatment options with other clinical colleagues as you might do with other patients. You can reassure the patient of confidentiality in any discussion and explain that this would be considered to be good practice.
It is important to remember that you have been tasked with providing medical advice and treatment. No amount of pressure should deter you from maintaining the professional boundaries of the doctor-patient relationship to the best of your ability.
When treating high profile patients, we also need to take particular care in discussing and considering the patient’s individual needs and circumstances. For example, would a possible treatment impact on their career or talent?
The Medical Council’s Guide states that doctors must give patients enough information, in a way that they can understand, to enable them to exercise their right to make informed decisions about their care.
It emphasises, in particular:
“Patients will always need basic information about their condition, its investigation and treatment, and any serious or frequently-occurring risks. Patients will usually need more detailed information about procedures that carry a high risk of failure or adverse side-effects. They will also need more detailed information about an investigation for a condition that, if found to be present, could have serious consequences for the patient’s employment, social or personal life.”
A cautious approach is, therefore, required if the patient is presenting with problems relating to their particular talent. For example, if a famous concert pianist presents with bilateral carpal tunnel syndrome and a specialist hand surgeon recommends surgery, should they fail to warn the patient about the possible complications, or discuss the options available, they leave themselves open to criticism if something goes wrong during the procedure. Although adverse complications would be distressing for any patient, the potential loss of earnings of a talented pianist could mean that a claim brought against the surgeon would be of a much higher value than a patient who doesn’t rely on their finger dexterity and strength to make a living. Such a claim may also be high profile with the risk of reputational damage.
When faced with treating a high-profile patient, many doctors react in different ways. Some will be nervous, worried the patient could ask them to go outside the boundaries of what they consider to be best practice, while others may feel intimidated or even flattered that they have been chosen to consult for medical treatment or advice.
Despite these feelings, as a professional, you must maintain the same high professional standards as to any other patient. Remember that the usual rules apply: Communicate openly; keep detailed medical records; manage professional boundaries; seek informed consent; and maintain their confidentiality.
You may feel extra pressure when dealing with those in the public eye, but as long as you act in their best interests and can justify any decisions you make, your integrity and professionalism should remain intact.
If in doubt, or if you require advice, always contact your medical defence organisation.
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