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Management

Think again before self-treatment

02/05/2019
By Karen Crouch
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It is all too easy for medical practitioners of all specialties to be tempted to treat themselves and family members. KAREN CROUCH looks at what can go wrong and why self-treatment is rarely a good idea.

Health practitioners may sometimes be tempted to administer their own healthcare - self-treatment - so it is appropriate to review the practice and, in particular, why it is not an advisable habit.

It is easy to understand why some may succumb to the temptation. After all, practitioners are trusted with the health and wellbeing of hundreds, indeed thousands, of clients. So, why would treating oneself or a family member put anyone’s health at risk?

Despite these natural urges to self-administer there are certain disadvantages that deserve review.

"Despite these natural urges to self-administer there are certain disadvantages that deserve review."

While the practice of self-treatment is not illegal, it is generally recommended by medical authorities that practitioners avoid treating themselves or immediate family as far as is practical. Additionally, it is also recommended that practitioners should have their own doctor or practitioner where necessary.

Where due consideration has been given to the relevant conditions under which self-treatment may be admissible, such as it being impractical not to do so or timing being critical, every effort must be made to err on the side of safety.

Keeping it impersonal

Let us review some of these potential challenges, particularly where treatment is administered to family members. Challenges include:

  • Care standards may be compromised, as a lack of objectivity may cloud professional judgment. This is more likely with self-treatment, as admission of a problem may be unconsciously ignored;

  • Close relationships may render taking or providing a complete history, sensitive aspects, or full physical examination uncomfortable for a practitioner or patient. This is more unlikely to occur during an examination by an independent practitioner;

  • Patients, particularly family members, may feel uncomfortable disclosing sensitive information that they would openly discuss with a non-relative practitioner;

  • Record keeping may be informal or non-existent, especially if the practitioner or family member’s health issue is a minor one and not be deemed to be of future relevance;

  • Family members may exert undue pressure for treatment, possibly contrary to a practitioner’s judgement, a situation which a non-relative practitioner would not normally be exposed to;

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  • Unforeseen adverse outcomes may result in intra-familial conflict.

Barriers to some of the abovementioned care conditions may result in practitioners employing inappropriate practices rather than seeking formal healthcare. These include inadequate preventative care, self-diagnosis, self-treatment and delayed presentation to other specialist or impartial practitioners.

A professional distance

Other more serious problems encountered in claims and advisory matters include:

  • Incorrect self-prescribing;

  • Inappropriate self-prescribing resulting in abuse of controlled substances – circumvents normal controls;

  • Poor referral and follow-up systems. Who obtains and actions results of tests or investigations requested by self-referring practitioners?

  • Confusion between self-treating practitioner and referral source. Who should initiate additional investigations?

  • Compromised or strained relationships with colleagues;

  • Clinical errors.

The family member who is a practitioner can, however, play a valuable role in the health care of their family, particularly in an advisory or advocacy role.

The following guidelines are suggested:

  • Every practitioner should have their own general or specialist practitioner;

  • Practitioners should assess circumstances where it is appropriate to treat family members, such as in the treatment of minor ailments and emergencies, rather than a primary, treating practitioner;

  • If the practitioner decides it is appropriate to treat, good medical records must be maintained, consultations should be formal, and follow up should be arranged.

  • Only discuss health of the family member with the usual treating practitioner who has knowledge and, presumably, the patient’s consent.

Health guidelines dictate that it is inappropriate to treat a family member if:

  • Prescribing or administering drugs of dependence (except in emergencies);

  • Prescribing psychotropic medication;

  • Undertaking psychotherapy;

  • Performing surgery.

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