Treating high-profile patients can often present a unique set of medico-legal challenges and it is important that doctors protect themselves, as well as the patient. Dr Emma Green discusses the common issues and gives advice.
Imagine you have a patient presenting with a viral sore throat and insisting on a course of antibiotics. In the case of the ‘everyday patient’, we know that the right thing to do usually is to advise on symptomatic treatment, not antibiotics.
But what would you do in a situation involving a high-pressure patient – perhaps a well-known politician or celebrity? 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 judgment 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 their medical condition and what you can do in your capacity as a doctor to help.
Open any gossip magazine and you will find examples of celebrities’ personal health and mental health battles. For doctors who treat these patients, dealing with issues around confidentiality can be problematic.
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.
Continuity of care
Your duty to your patient includes ensuring there is continuity of care. Omitting information from the record could mean other healthcare professions are misinformed about their condition.
The GMC’s guidance on this matter is clear. Its publication Decision Making and Consent states: ‘Keeping patients’ medical records up to date with key information is important for continuity of care. Keeping an accurate record of the exchange of information leading to a decision in a patient’s record will inform their future care and help you to explain and justify your decisions and actions.’
However, under the General Data Protection Regulation, patients have the right to ensure their information is accurate and they can request factual inaccuracies in their record to be rectified.
But they do not have the right for a medical opinion made by you as a professional to be changed. The Information Commissioner’s Office has further detail about complying with these requests, situations where requests may be refused, and also time-scales.
If you need to make a correction, make sure you enter the date of the amendment and include your name. You should only comply with a request if you are satisfied the entry is indeed factually inaccurate, but if you decide a correction is not warranted, you should annotate the disputed entry with the patient’s view.
Even the most demanding of patients should understand that it is your professional obligation to keep a record of their care, for their well-being and yours.
Reassure them that they can take comfort in the fact 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 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 worse-case scenario would be if the patient was 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 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?
A cautious approach is also required if the patient is presenting with problems relating to their particular talent.
For example, if a well-known singer presents with increasing hoarseness and an ear, nose and throat specialist confirms polyps on the vocal cords. If you fail to warn them about the possible complications, or discuss the options available, you leave yourself 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 famous singer could mean a claim brought against you would be of a much higher value than a patient who does not rely on their voice to make a living. And this sort of claim may also risk damaging your reputation.
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.
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. The usual rules apply:
Keep detailed medical records;
Manage professional boundaries;
Seek informed consent;
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.
Dr Emma Green (right) is a medico-legal consultant at Medical Protection