Self-treatment – think again

It’s generally recommended by medical authorities that practitioners should avoid treating themselves or immediate family as far as practical, and instead should have their own GP or specialist. This guideline is both prudent and common sense.

However, in the COVID era the entire concept of self-treatment has required both governments and medical authorities to constantly review the situation as deeper knowledge is acquired about the the virus and potential treatments.

Consequently, never-ending PCR testing (the most conventional, reliable method) queues, coupled with scientific developments, have seen the introduction of Rapid Antigen Testing (RATs) for use by individuals in their homes or at medical/ pharmaceutical centres. While a PCR test is recommended for RAT-positive results, the result not being reported is an undesirable risk but, most importantly, it entrusts the person with the responsibility of following through with a PCR test.

Let’s try to review the wise advice on both self-treatment by individuals and/or medical persons in the context of normal (pre-pandemic) conditions and related responsibilities and obligations to other community members from possible non- compliance.

Undoubtedly, there are risks associated with practitioners treating themselves or family members. As a general rule, treatment should only be given after due consideration of potential problems that may arise.

The potential challenges for both the abovementioned options include:

• Care standards may be compromised as lack of objectivity may cloud professional judgment;
• Close relationships may render taking or providing a complete history, sensitive aspects, or full physical examination uncomfortable for practitioner and/or patient;
• Patients may feel uncomfortable disclosing sensitive information;
• Record keeping may be informal or non- existent, to the detriment of patient care;
• Family members may exert undue pressure for treatment against a practitioner’s judgement; and
• Unforeseen adverse outcomes may result in intra-familial conflict.

Barriers to care may result in practitioners employing inappropriate practices rather than seeking formal healthcare advice. These include inadequate preventative care, self-diagnosis, self-treatment and delayed referral to other practitioners. Practitioners are often reluctant to consult another for independent medical advice. Similarly, they may not adhere to routine preventative health measures, such as screening tests and vaccinations.

Introduction of COVID-19 has also triggered a number of opinions by ‘experts’, challenging both individuals and practitioners with sometimes differing views.

Problems encountered in claims and advisory matters include:

• Incorrect self-prescribing;
• Inappropriate self-prescribing resulting in abuse of controlled substances;
• 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; and
• Clinical errors.

The family member who is a practitioner can, however, play a valuable role in the care of their family, particularly in an advisory or advocacy role as it is fair to assume such professionals will be familiar with information on the rapidly changing social, medical and other relevant environmental conditions – vital knowledge during an incident like the current pandemic.

While self-treatment of a family member by a practitioner is not forbidden, the following guidelines are suggested:

• Every practitioner should have their own general or specialist practitioner;
• Practitioners should assess circumstances where it’s appropriate to treat family members – treatment of minor ailments and emergencies rather than primary, treating practitioner;
• If the practitioner decides it’s appropriate to treat, good medical records must be maintained, consultations should be formal, follow up should be arranged, and details regarding treatment communicated to the family member’s usual treating practitioner; and
• Only discuss health of family members with the usual treating practitioner who has knowledge and, presumably, the patient’s consent.

Naturally, if in doubt or considered appropriate, practitioners ought to seek a second opinion from a specialist in the particular illness being addressed who would have deeper knowledge of the situation.

However, it’s inappropriate for a practitioner to treat a family member if:

• Prescribing or administering drugs of dependence (except in an emergency);
• Prescribing psychotropic medication; • Undertaking psychotherapy; or
• Performing surgery.

In summary, treating yourself and family members may seem harmless, but the risks can outweigh the benefits. Practitioners may inadvertently, albeit with every fine intention, create a situation where high quality, medical care is compromised. Likewise, individuals employing approved self- treatment methods such as aforementioned RATs should never hesitate to consult a more qualified practitioner or expert in their field of expertise.

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