High profile patients

Treating high-profile patients can often present a unique set of medicolegal challenges and it is important that doctors protect themselves, as well as the patient. Dr Emma Green, Medicolegal Consultant at Medical Protection, discusses the common issues and sets out some advice

When a high-profile patient dies, the circumstances around their death and sometimes their relationship with their doctor can be thrown into the media spotlight. This is a daunting prospect for doctors.  Although very few doctors will face such an extreme situation, it is useful to be aware of some of the potential medicolegal challenges that can arise when treating someone in the public eye.

Imagine you have a patient presenting with a viral sore throat and insisting on a course of antibiotics. In the case of the ‘everyday patient’, we know that the right thing to do usually is to advise on symptomatic treatment, not antibiotics. But what would you do in a situation involving a high-pressure patient – perhaps a well-known politician or celebrity? Would you feel it safer to prescribe the antibiotics when your patient is in a position of power and used to getting what they want?

From a medicolegal point of view, of course, your medical judgement should not be swayed depending on the social status, wealth or other influence of the patient you are treating. As a doctor, you have a duty of care to all your patients regardless of whom they are. Your prime consideration should be regarding their medical condition, and what you can do in your capacity as a doctor to help.

Confidentiality

Open up any gossip magazine and you will find examples of celebrities’ personal health and mental health battles. For doctors who treat these patients, dealing with issues around confidentiality can be problematic. As a result, celebrities may request for details of their medical condition to be omitted from their records, or for no records to be made, in fear of it being leaked into the public domain.

The first step is to instil trust between yourself and the patient. Everyone has a right to confidentiality and high-profile patients may need extra reassurance that this right will be respected. However, it is never appropriate to intentionally leave relevant clinical information out of a medical record and this must be explained to the patient. Your duty to your patient includes ensuring that there is continuity of care - omitting information from the record could mean other healthcare professions are misinformed about their condition.

The GMC’s guidance on this matter is clear; in its publication, Decision Making and Consent, it states: “Keeping patients’ medical records up to date with key information is important for continuity of care. Keeping an accurate record of the exchange of information leading to a decision in a patient’s record will inform their future care and help you to explain and justify your decisions and actions.”

However, under GDPR, patients have the right to ensure their information is accurate and are able to request that factual inaccuracies within their record are rectified. They do not however, have the right for a medical opinion made by you as a professional to be changed. The Information Commissioner’s Office has further detail in relation to complying with these requests, situations where requests may be refused, and timescales. If you need to make a correction, make sure you enter the date of the amendment and include your name. You should only comply with a request if you are satisfied that the entry is indeed factually inaccurate, but if you decide that a correction is not warranted, you should annotate the disputed entry with the patient’s view.

Even the most demanding of patients should understand that it is your professional obligation to keep a record of their care, for their wellbeing and yours. Reassure them that they can take comfort in the fact that there are laws to protect against disclosure against their wishes, and ensure their need for confidentiality is respected.

Pressure

Sometimes, despite building up a trusting doctor-patient relationship, outside influences such as celebrities’ managers or other individuals involved in their day to day lives may take it upon themselves to make decisions on behalf of their client. This can pose problems when the decisions they make are in conflict with what you believe to be in the patient’s best medical interests.

If you feel you are being pressured into a decision by a patient or third party, take time to consider your position. Ultimately, the right thing to do is to outline your concerns, the options and tell them what the worse-case scenario would be if the patient was to refuse the advice. You cannot enforce any treatment without the patient’s consent, apart from in emergency situations. Equally, you shouldn’t proceed with treatment that you think is wrong merely because the patient has requested it. As with any patient, ensure you include details of all these discussions, including any refusal to treatment, in the medical notes.

You may wish to obtain the patient’s consent to discuss potential treatment options with other clinical colleagues as you might do with other patients. You can reassure the patient of confidentiality and explain that this would be considered to be good practice.

It is important to remember that you have been tasked with providing medical advice and treatment. No amount of pressure should deter you from maintaining the professional boundaries of the doctor-patient relationship to the best of your ability.

When treating high profile patients, we also need to take particular care in discussing and considering the patient’s individual needs and circumstances. For example, would a possible treatment impact on their career or talent?

A cautious approach is also required if the patient is presenting with problems relating to their particular talent. For example, if a well-known singer presents with increasing hoarseness and an ear, nose and throat specialist confirms polyps on the vocal chords; failure to warn them about the possible complications, or discuss the options available, could leave you open to criticism if something goes wrong during the procedure. Although adverse complications would be distressing for any patient, the potential loss of earnings of a famous singer could mean that a claim brought against you would be of a much higher value, than a patient who doesn’t rely on their voice to make a living. Such as claim may also be high profile with the risk of reputational damage.

Starstruck

When faced with treating a high-profile patient, many doctors react in different ways. Some will be nervous, worried the patient could ask them to go outside the boundaries of what they consider to be best practice, and some may feel intimidated or even flattered that they have been chosen to consult for medical treatment or advice.

Despite these feelings, as a professional, you must maintain the same high professional standards as with any other patient. Remember that the usual rules apply: communicate openly, keep detailed medical records, manage professional boundaries, seek informed consent, and maintain their confidentiality.

You may feel extra pressure when dealing with those in the public eye, but as long as you act in their best interests and can justify any decisions you make, your integrity and professionalism should remain intact.

If in doubt, or you require advice, always contact your medical defence organisation.

Media Scrutiny

Dealing with high-profile patients can lead to enquiries from the media. Breaking confidentiality, whether inadvertently or not, could lead to a complaint, disciplinary action, or regulatory sanction. However saying “no comment” to a journalist can come across as defensive, and there are ways in which you can respond to media enquiries without breaching confidentiality.

Media scrutiny could put your personal and professional reputation at risk, but early advice from the Medical Protection Press Office can help to mitigate this. Media advice is available to our members 24 hours a day, 7 days a week.