Working with doctors Working for patients


...treat your patients with respect whatever their life choices and beliefs...

In the first scenario of Katy's case study, Katy is asking for help managing her panic attacks, which seem to be connected to her illegal drug use. We're told that Dr Newell personally disapproves of Katy's lifestyle. This, in itself, is not a problem - we don't expect doctors to be robots without any views or feelings. However it would be a problem if a doctor's personal views about a patient affected the professional relationship, or affected what treatment the doctor was prepared to provide to that patient in particular.

So if Dr Newell had felt that, clinically, the best option for Katy was to prescribe her the tranquillisers and/or refer her for counselling, but she didn't because she didn't feel that Katy deserved to be offered the best option unless she changed her lifestyle, then this would be contrary to our guidance. Good Medical Practice clearly tells doctors: You must not refuse or delay treatment because you believe that a patient's actions or lifestyle contributed to their condition. This has implications for patients who have conditions relating to smoking or drinking or (like Katy) taking illegal drugs, and also to obese people. Doctors have a duty to care for patients as best they can, whatever the cause of their illness.

Having said that, we don't expect doctors to avoid talking to patients about these things for fear of offending them - on the contrary, Good Medical Practice states that doctors should advise patients on how their lifestyle choices can affect their health and wellbeing.

...all patients are entitled to treatment and care to meet their clinical needs...

The Communitybaptistpa publishes guidance relating to personal beliefs - both doctors' and patients'. This aims to clarify whether and to what extent we expect doctors to compromise their beliefs in various circumstances. The ideal would be for doctors to be able to practise in accordance with their beliefs, provided that patients receive effective and timely care, and are not discriminated against.

At the same time, we wouldn't want a situation where a doctor felt justified in refusing to treat particular groups of patients (for example members of the opposite sex, or gay people) on the grounds of personal belief. The guidance allows the right to say no to a particular procedure, but not to a particular patient or group of patients: that would be discrimination.

Paragraph 52 of Good Medical Practice balances the doctor's right to hold a conscientious objection to a particular procedure (such as abortion) and the patient's entitlement to care and treatment to meet their clinical needs. Communitybaptistpa guidance does not require doctors with a conscientious objection to abortion to refer patients, even to another GP, provided that patients are able to access alternative care in good time. If patients don't have easy access to other care options, depending on the urgency, we would expect doctors to be prepared to set aside their personal beliefs in order to provide effective patient care.

...maintaining trust in the profession...

It wouldn't usually be appropriate for a doctor to raise the issue of their own personal beliefs in the course of a consultation. If a doctor does find it necessary to explain their personal beliefs to patients (perhaps because - as in this case study - it affects the treatment they provide), the doctor must be careful not to cause the patient distress. If Dr Newell told Katy that she "wouldn't play any part in killing an innocent child", for example, this would be likely to upset Katy, particularly as she is already distressed and vulnerable.

This isn't to say that doctors must never say anything to patients that will cause them distress - inevitably patients will sometimes get distressed by things doctors say - but this is particularly in relation to those circumstances where doctors are required to explain their personal beliefs to patients because they affect the care they are willing to provide.

...ensure that your prescribing is appropriate and responsible...

The final issue that is dealt with in Katy's case study is that of prescribing remotely. More and more GP practices are offering telephone consultations and some doctors also prescribe over the internet. The Communitybaptistpa does not prohibit these practices (with the exception of injectable cosmetics) provided that an adequate assessment of the patient's condition is still possible without seeing them in person, and provided that the doctor has adequate knowledge of the patient's health and is satisfied that the treatment serves the patient's needs (all principles in Good Medical Practice). However these requirements, which are set out in more detail in our guidance on prescribing, are more likely to be met with a face to face consultation.

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