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Know your competence limits: don’t prescribe unfamiliar treatments, GPs warned

Warning prompted by rising number of patients treated overseas

Caroline White

Tuesday, 30 April 2013

Doctors shouldn’t feel pressurised into prescribing unfamiliar drugs to patients who have received medical treatment abroad, warns medical defence organisation MDDUS (Medical and Dental Defence Union of Scotland).

The warning comes amid a growing number of calls from doctors seeking advice from the MDDUS on responding to requests by patients to prescribe treatments recommended by overseas doctors.

Some of the drugs are not even licensed in this country and, according to MDDUS medical adviser Dr Mary Peddie, doctors should treat such requests in the same way as if the recommendation came from a UK specialist.

“Doctors must be prepared to explain and justify their decisions and actions when prescribing, administering, and managing medicines. This advice also applies to patients who purchase medicines on the internet and want the GP or practice nurse to administer injections,” explains Dr Peddie.

Many of the cases referred to MDDUS involve patients going overseas for fertility treatment where costs may be lower and/or the availability of donors greater, she says.

“On their return, some patients want their GP to provide medication which, in the UK, is usually provided by the specialist unit. The medication recommended may not be in use in this country, or may even be unlicensed here,” she says.

Doctors should refer to Good Medical Practice guidance published by the regulator, the General Medical Council, she reminds practitioners.

This requires a doctor who prescribes on the recommendation of another doctor or health professional, to satisfy themselves that the prescription is needed, is appropriate for the patient, and is within the limits of the prescriber’s competence.

The guidance is equally applicable irrespective of whether the treatment is being recommended by someone outside of the UK.

The guidance also says that if doctors prescribe an unlicensed medicine, they must be satisfied that there is sufficient evidence of the medicine’s safety and efficacy and also that they are prepared to take responsibility for overseeing the patient’s care, monitoring, and follow-up or ensure that another doctor can do so.

“If you do not consider that you have the appropriate knowledge and experience to prescribe a particular medicine, you do not have to do so. But you should explain your reasons for declining and explain other available options, including the option to seek a second opinion,” says Dr Peddie.

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