I did the legal thing – but did I do the right thing?

Ines Rio

16/10/2018 11:58:48 AM

Dr Ines Rio reflects on battling bureaucratic rules on behalf of a patient.

The computer said no: How do you fight against bureaucracy for your patients?
The computer said no: How do you fight against bureaucracy for your patients?

Several weeks ago, a patient I see monthly told me about her mouth pain.
She came to me for follow-up after a recent mastectomy for breast cancer (and for her goserelin implant, premature menopause and her many other post-cancer-diagnosis psychosocial and health considerations).
Examination revealed several small mouth ulcers. She was otherwise well.
I did an urgent full blood examination (FBE), as I was concerned about a neutropenia, and a swab for herpes.
The FBE was normal, which was a relief. But the herpes polymerase chain reaction (PCR) came back several days later positive for herpes type 1. By then, her ulcers had healed.
She came back in recently with a one-day history of similar symptoms of quite severe mouth pain affecting her ability to eat and drink.
On examination, there were eight new grouped ulcers. Through an interpreter, I explained the diagnosis of recurrent herpes, what this meant and that I’d prescribe antivirals, topical anaesthetic gel and, if needed, a non-steroidal anti-inflammatory.
But when I went to prescribe the antiviral, I found that recurrent mouth ulcers are not a Pharmaceutical Benefits Scheme (PBS) indication. Genital, yes. Mouth, no. I rang the authority line and spoke to a person to ask if there was a category I could use.
My patient’s body mass index (BMI) is 18, she is having cancer treatment, and has absolutely no ability to afford a private script. But the computer said no. 
Was there someone I could speak with who had the authority to allow me to prescribe this? I asked. No, no, no. And so she left without an antiviral script, with me thinking that I’d done her a disservice and that this is madness.
Madness there is not a clinician who can be accessed with the authority to override an inflexible bureaucratic system in the case of clear clinical need.
Madness that in this age of patient-centred care I have no ability to make the call for the patient before me.
Madness that this can so understandably lead to GPs ‘bending the truth’ to help their patients.  
I can’t help thinking I should have just lied. Would you have?

bureaucracy patient-centred care red tape


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