Physician, (do not) heal thyself

The doctor who called us was stunned. They had been reported to AHPRA and were being investigated for self-prescribing*.
 
‘It’s my business if I prescribe to myself; and anyway, these were not Schedule 8 medicines!’
 
And so began a discussion of how the Medical Board views self-treatment by medical practitioners, and how this has changed over the years.
 
There is broad recognition that our health and wellbeing impacts on our practice, and we are extolled to accept self-care as a cornerstone of professional life. However, there are distinct limits to the self-care we can and should provide to ourselves.
 
Stepping into providing ourselves care that only a registered health practitioner could deliver, likely means we are stepping outside the Medical Board’s Code of Conduct guidelines, with the risk of poor care outcomes or investigation.
 
Every year, there are examples of practitioners who have registration-impacting outcomes at tribunals resulting from inappropriate self-care and care boundaries.
 
Section 11 of the Code, a relatively recent addition, talks about managing one’s own health. This section reflects similar constraints to the provision of care to close friends, family, and those you work with, discussed in section 4 (which was also updated).
 
Medical practitioners should not be self-prescribing
This isn’t just a reference to self-prescribing Schedule 8 drugs (which most jurisdictions restrict or prohibit) or select Schedule 4 drugs, including drugs of dependence.
 
It refers to all prescriptions by a practitioner for themselves.
 
In addition, practitioners risk breaching the specific, varying, and complex legislative restrictions on self-prescribing in each jurisdiction – ranging from full self-prescribing prohibition (Victoria) through restrictions on prescribing Schedule 8 drugs and some Schedule 4 medicines (Queensland, ACT, NSW, potentially WA/NT); or restrictions on self-prescribing Schedule 8 drugs. Such breaches may be a criminal offence.
 
Health practitioners should have their own GP
While I’m sure we all subconsciously self-diagnose at times, the value of independent objective workup, investigation and treatment cannot be overstated.
 
This includes the importance of approaching your treating team for documents like medical certificates, and not issuing these yourself.
 
Seek advice
There is additional emphasis on the importance of seeking advice in relation to health issues that could impact your work, including stress, burnout and mental health.
 
Contact the DHAS
If you have troubles locating a GP, the Doctors Health Advisory Service (DHAS) in your jurisdiction may be able to assist in finding GPs who have identified themselves as having an interest in looking after the health of their colleagues.
 
They can also provide confidential telephone call-back support in more acute circumstances, such as mental illness, stress, drug and alcohol dependence, and other personal issues.
 
Mandatory reporting reassurance
Where doctor-patients follow their treating team’s advice on whether their health issue impacts on work and how they should manage this (including modifying their practice), there should be no basis for a mandatory report.
 
Complaints are generally straightforward to deal with if the doctor has sought and followed their treating practitioner’s advice. It is more common for doctors who do not have a treating team to find themselves in difficulty if a concern about health impairment is made to a health complaints body.
 
Tragically, we are also aware of terrible outcomes arising when doctors attempt to manage their own substance misuse or significant mental health conditions.
 
This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy or medico-legal matters. Members can contact MDA National for specific advice on freecall 1800 011 255 or use the ‘contact us’ form at mdanational.com.au.
 
*This case study is based on an actual request for medico-legal advice, however certain facts have been omitted or changed to ensure the anonymity of the parties involved.
 
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AHPRA Code of Conduct MDA National self-prescribing self-treatment