Corridor consultations with colleagues - an ethical dilemma

Seeing staff as patients

Time-poor hospital staff and easy access to doctors means you will inevitably have to deal with requests to provide health advice and care to your work colleagues.

How could you not write a script if their contraceptive has run out, or prescribe sleeping tablets in the middle of a run of nights? It’s always ‘just’ a pathology test, a referral, or a quick question to save them the hassle of booking a GP.

What we so easily overlook is that when you provide health advice and care in these situations, your colleague becomes your patient, whether you like it or not. And if your colleague is now your patient, how do you manage the doctor–patient boundaries when they invite you down to the pub?

Most ‘corridor consultations’ are a shadow of proper care

We cannot emphasise enough that serious complaints, employment matters and claims do arise from such care. Healthcare workplaces should have a policy discouraging, or carefully managing, clinical care being provided by staff to staff wherever possible. 

In the rare case where this care is necessary and unavoidable, such as at a remote placement, do yourself and your colleague a favour and treat them properly as a patient. Structure the care as you would any other patient consultation, making it clear that this is non-negotiable.

The expected level of care

The Medical Board, your hospital or workplace, the coroner and the courts will all expect a certain level of care. 

Did you:

• take a full history?
• properly examine your patient?
• objectively consider the differentials?
• document your findings?
• inform the usual treating doctors to maintain continuity of care?
• obtain informed consent?
• ensure appropriate follow-up occurs?

And the list goes on.

A stark warning

The Medical Board’s code of conduct provides a stark warning. They are the ‘bad cop’ you can refer to when responding to a ‘corridor consultation’ request, if there’s no other way out. 

According to Good medical practice: a code of conduct for doctors in Australia:

4.15 Providing care to those close to you

Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with, and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the patient and doctor. 

In particular, medical practitioners must not prescribe Schedule 8, psychotropic medication and/or drugs of dependence or perform elective surgery (such as cosmetic surgery), to anyone with whom they have a close personal relationship.

In some cases, providing care to those close to you is unavoidable, for example in an emergency. Whenever this is the case, good medical practice requires recognition and careful management of these issues.

The staff member was encouraged to see their own GP and was subsequently referred to a dermatologist. This was fortunate, as that freckle was an atypical melanoma. It would have been so easy to have glibly reassured them it was nothing to worry about.

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