Pushing the boundaries

Nerissa Ferrie

26/04/2021 3:45:08 PM

SPONSORED CONTENT: In general practice, there is a wide range of tolerance when it comes to patients who push legal and therapeutic boundaries.

Silhouette of doctor talking to patient.
The enormous trust placed in doctors can be a double-edged sword.

Calls to the medico-legal advisory services team demonstrate how tolerance for pushing boundaries can differ significantly between individual doctors.
Case study
Dr Jones has been treating Maddison and her young son for the past year. Custody has been an ongoing issue, and Dr Jones has provided a number of letters and reports for use in the Family Court.
Maddison has openly disclosed her recreational drug use to Dr Jones, and this is documented in the notes. In addition to her disclosures, Maddison recently had her licence suspended for driving under the influence of alcohol and methamphetamines, which came to light when she asked Dr Jones to write a letter of support for her appearance in court.
Dr Jones received a request for a report from the Independent Children’s Lawyer (ICL) prior to an upcoming custody hearing. Dr Jones advised Maddison of the request, and she pleaded with him not to disclose the driving charge, or her drug and alcohol use, for fear of losing custody of her child. He felt sorry for Maddison, and thought she was doing her best to turn her life around.
Even though two questions specifically referred to illicit drugs and alcohol, Dr Jones failed to disclose the patient’s ongoing methamphetamine and alcohol misuse. Dr Jones contacted his medical defence organisation (MDO) for advice after he received a subpoena to produce notes and to give evidence in the Family Court proceedings.
Unfortunately, Dr Jones was questioned under oath and had to admit to the court that he had not fully disclosed his patient’s drug use in the report he provided to the ICL. The ICL made a notification to Australian Health Practitioner Regulation Agency (Ahpra) on the basis that Dr Jones breached the Code of Conduct by deliberately omitting relevant information that could have been detrimental to the child’s best interests.
Medico-legal discussion
The enormous trust placed in doctors can be a double-edged sword.
On one hand, a trusting patient will disclose information to their GP that they may not disclose to others in their lives. But on the other, law enforcement, the courts, employers, and insurers also trust that the information they receive from a doctor will be truthful.

According to the Code of Conduct, good medical practice involves:

  • being honest and not misleading when writing reports and certificates, and only signing documents you believe to be accurate
  • taking reasonable steps to verify the content before you sign a report or certificate, not omitting relevant information deliberately
  • preparing or signing documents and reports if you have agreed to do so, within a reasonable and justifiable timeframe
  • making clear the limits of your knowledge and not giving opinion beyond those limits when providing evidence.
Take-home message
It is admirable when GPs advocate for their patients and do their best to ensure excellent clinical care, but this should never be at the expense of the doctor’s professional and ethical obligations.
We know doctors are among the most trusted professions in Australia, but it is important for all doctors to respect professional boundaries and ensure that trust is deserved. A poor decision made in the best interests of one patient may blemish a reputation that has taken years to build.
If you feel a patient may be crossing the line, and you would like advice on how to politely decline an inappropriate request, call your MDO for advice.

The article was commissioned by newsGP and provided by MDA National.
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