PRESCRIBING: RELUCTANT TO REVIEW
BACKGROUND: A 53-year-old patient, Mrs B, has been on a repeat prescription for diazepam for the past 10 months. She has been invited for a medication review on two occasions but has failed to respond to letters and phone calls from the practice. Her GP, Dr D, is growing increasingly concerned about the
potential consequences of continuing to prescribe the drug without being able to sufficiently monitor the patient’s health. He is also worried about the impact of stopping the repeat prescription and contacts MDDUS for advice on how to proceed. ANALYSIS/OUTCOME: An MDDUS adviser acknowledges the challenge of treating patients who fail to attend for review and highlights GMC guidance which states that, when prescribing, doctors must have adequate knowledge of the patient’s health and be satisfied that the drugs or treatment prescribed serve the patient’s need. Doctors reviewing a repeat prescription must make sure that suitable arrangements are in place for monitoring, follow-up and review. Medication reviews are considered particularly important in patients who may be frail or with multiple illnesses. Guidance also requires doctors to give particular consideration to those medicines with potentially serious or common side-effects. In re-prescribing a medication, doctors are advised to ensure the prescription is safe and appropriate and to agree with
patients how their condition will be managed, including dates for review. The guidance also requires a doctor to ensure that clear records are made in relation to prescribing. Mrs B’s refusal to attend for review presents a difficult
situation. The doctor is advised to clearly record all attempts to invite the patient in for review and to keep copies of all correspondence. There should be a note in the patient records alerting other practice staff to the need for an opportunistic medication review the next time Mrs B attends the surgery. Should she continue to default, the risks and benefits of continuing to prescribe without review should be weighed up and a decision made and fully documented. The doctor is advised to consider inviting Mrs B in for a face-to-face discussion before making any decision about stopping the prescription as there may be other reasons behind her refusal to attend. Dr D is also encouraged to discuss the matter with practice colleagues to agree on a course of action that takes into account the patient’s individual circumstances.
KEY POINTS • Ensure the practice has an adequate system to review repeat prescribing.
• Use all practical means to invite patients for review. • Give careful consideration in managing repeat prescribing, taking account of individual circumstances.
CONFIDENTIALITY: A WRONG MESSAGE
BACKGROUND: Mrs M attends her dentist, Mr A, complaining of pain in an upper tooth. They discuss treatment options and she agrees to undergo private treatment, including root filling and the fitting of a new crown. The treatment is carried out without incident and Mrs M pays part of the bill before leaving that day. The practice sends out an account detailing
the remaining total but, three months later, no further payments have been made. Mr A issues another written account to Mrs M but is then contacted by Mr M who says he is assuming responsibility for the bill. Five months after the initial appointment
still no further payment has been made. Mr A phones Mr M at home to discuss the matter. There is no answer but the phone switches to an answering machine, identified as belonging to Mr and Mrs M. He leaves a message asking Mr M to contact the practice about the unpaid bill. One week later, Mr A receives a cheque for £150 from Mr M along with a promise that more money will follow soon. It is also accompanied by a letter of complaint from Mr M who is angry that the dentist disclosed information about the unpaid bill in the answering machine message. His daughter had dropped by while he was out and heard it, causing him considerable embarrassment.
SPRING 2015 Mr A sends a written apology to Mr M and agrees to let him
pay the bill off over the next two months. A short time later, however, Mr A is notified by the General Dental Council that a complaint has been made against him alleging a breach of confidentiality.
ANALYSIS/OUTCOME: Mr A calls MDDUS for advice. It is recommended he writes a further letter of apology to Mr M, accepting that sensitive information about the unpaid bill should not have been disclosed in the phone message and that practice procedures have been changed to avoid a repeat of this error. It is also suggested that Mr A waives the outstanding sum owed to the practice in
recognition of the distress caused by the breach. The GDC case is eventually closed with no action taken
against Mr A.
KEY POINTS • Only contact patients by telephone with their express consent.
• Never disclose sensitive patient information in telephone messages.
• Be aware of the potential for third parties to intercept messages, even on personal mobile phones.
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