HEALTH PROMOTION

THE LEGAL IMPLICATIONS OF EXERCISE PRESCRIPTION

Telling someone to do more exercise sounds like indisputably good advice. Doctors ‘prescribing’ exercise for patients sounds like an even better idea. But warn- ings that patients could hold their GPs liable for suffering ill-health as a result of these well-intentioned prescriptions has cast a shadow over the success of these schemes.

Ironically it comes at a time when the Government is actively promoting exer- cise. The White Paper, ‘Our Healthier Nation: Saving Lives’ praises ‘exercise on prescription’ as ‘more effective and cheap- er than medication’ and promises support for such schemes in the Government’s sports strategy, due this autumn. But legal insurers feel that the concept of exercise ‘prescription’ is quite literally an accident waiting to happen and are warn- ing GPs to be cautious. Subsequently both medical and sports professionals are left needing reassurance.

The problem Dr Peter Schutte, director of legal services at the Medical Defence Union warns, ‘If a GP ‘prescribes’ exercise to a patient who subsequently suffers a myocardial infarc- tion whilst exercising, for example, the doctor could be made unnecessarily vul- nerable to a claim for damages.’

patient’s suitability to exercise.’

Dr Domhnall MacAuley, professor of prima- ry health care research at the University of Ulster and editor of the British Journal of Sports Medicine says there are two fun- damental problems with exercise prescrip- tion. ‘Firstly when referring a patient the GP must be able to vouch for the qualifi- cations of the person to whom they are referring. And however well trained most exercise professionals are they are not usually medical professionals – it is a dif- ferent matter if we were referring to a medically trained specialist.’

‘The second equally important problem is that most GPs have no specialist training in exercise and so most would be unable to carry out a full assessment of a

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‘A thorough exercise assessment would require an exercise stress test. In a court of law it is frighteningly easy to discredit practice even when you think you’ve acted 100 per cent correctly.’

‘At the end of the day it’s the defence unions who support us in our time of need and I wouldn’t dare overstep their advice,’ Dr MacAuley adds.

He believes the leisure industry does not understand why GPs are reluctant to refer patients for exercise. ‘Doctors are going to be guided by the defence organisations. It is not an issue of talking to the leisure industry.’

Dr Sophie Burrows, a GP in Gloucestershire who also has a masters degree in law, and has written an article in the latest issue of The British Journal of Sports Medicine on the subject says as far as the defence unions are concerned the potential prob- lem comes in the use of the word ‘pre- scribe’. ‘This implies that the doctor knows exactly what he/she has ordered and takes responsibility for it. When in fact many GPs may not realise the implications of exercise prescription for certain individual patients.’

Dr Burrows believes that if a case of this kind was brought to court two specific issues are likely to be raised. Firstly the court may consider whether prescribing exercise is ordinarily an activity undertak-