A doctor has duties to discuss any changes to a patient’s medication with the patient under law, under the GMC and the RCGP

[NBob]

1.0 Law

A doctor has a legal duty to discuss any changes to a patient’s medication with the patient.

This duty arises under section 2 of the Health Act 2009 which states that each person who provides NHS services under a contract, agreement or arrangements … must, in doing so, have regard to the NHS Constitution.

The NHS Constitution states that You have the right to be involved in discussions and decisions about your healthcare, and to be given information to enable you to do this.

2.0 General Medical Council

The GMC has published an overarching statement of duties called Good Medical Practice (2010) and supplementary guidance called Consent: patients and doctors making decisions together (2009).

2.1 Good Medical Practice

The General Medical Councils has published Good Medical Practice which states the duties of a doctor registered with the General Medical Council. The preamble states that a doctor must

Work in partnership with patients

- Listen to patients and respond to their concerns and preferences

- Give patients the information they want or need in a way they can understand

- Respect patients’ right to reach decisions with you about their treatment and care

Good Medical Practice at paragraph 22(b) states that a doctor must share with patients, in a way they can understand, the information they want or need to know about their condition, its likely progression, and the treatment options available to them, including associated risks and uncertainties.

2.2 Consent: patients and doctors making decisions together 2009.

The GMC clarify how a doctor should discuss involve the patient I investigations and treatment in their publication: Consent: patients and doctors making decisions together 2009.

At paragraph 2 it states that a doctor must work in partnership with his/her patients to ensure good care.

At paragraph 5 it states

If patients have capacity to make decisions for themselves, a basic model applies:

(a) The doctor and patient make an assessment of the patient’s condition, taking into account the patient’s medical history, views, experience and knowledge.

(b) The doctor uses specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient. The doctor explains the options to the patient, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice.

(c) The patient weighs up the potential benefits, risks and burdens of the various options as well as any non-clinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which one. They also have the right to accept or refuse an option for a reason that may seem irrational to the doctor, or for no reason at all.

(d) If the patient asks for a treatment that the doctor considers would not be of overall benefit to them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. But they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.

At paragraph 7 it states that the exchange of information between doctor and patient is central to good decision-making. How much information the doctor share with patients will vary, depending on their individual circumstances. The doctor should tailor his/her approach to discussions with patients according to:

(a) their needs, wishes and priorities

(b) their level of knowledge about, and understanding of, their condition, prognosis and the treatment options

(c) the nature of their condition

(d) the complexity of the treatment, and

(e) the nature and level of risk associated with the investigation or treatment.

At paragraph 9 it states that the doctor must give patients the information they want or need about:

(a) the diagnosis and prognosis

(b) any uncertainties about the diagnosis or prognosis, including options for further investigations

(c) options for treating or managing the condition, including the option not to treat

(d) the purpose of any proposed investigation or treatment and what it will involve

(e) the potential benefits, risks and burdens, and the likelihood of success, for each option; this should include information, if available, about whether the benefits or risks are affected by which organisation or doctor is chosen to provide care

(f) whether a proposed investigation or treatment is part of a research programme or is an innovative treatment designed specifically for their benefit

(g) the people who will be mainly responsible for and involved in their care, what their roles are, and to what extent students may be involved

(h) their right to refuse to take part in teaching or research

(i) their right to seek a second opinion

(j) any bills they will have to pay

(k) any conflicts of interest that you, or your organisation, may have

(l) any treatments that you believe have greater potential benefit for the patient than those you or your organisation can offer.

At paragraph 10 it states that the doctor should explore these matters with patients, listen to their concerns, ask for and respect their views, and encourage them to ask questions.

3.0 Good Medical Practice for General Practitioners

The Royal College of General Practitioners has it own guidance for GPs. It classifies certain actions by GP as exemplary or unacceptable.

It states that the exemplary GP, amongst other things

• encourages patients to become full partners in their care.

• involves patients in decisions about their care

It also states that the unacceptable GP

• does not explain clearly what he or she is going to do or why

• gives treatments that are inconsistent with best practice or evidence

• ignores the patient’s best interests when deciding about treatment or referral

• makes little effort to ensure that the patient has understood his or her condition, its treatment and prognosis

Not conforming to the guidance is not an offence but non-conformances should be used as evidence in any complaints against your doctor.

[shaws Administrator]

Thanks for this post. It is very informative and gives me a bit of 'push' when I know whether or not I will be prescribed NDT on the NHS.

[nostoneunturned]

Thank you, NBob, so helpful. I'll arm myself with this and read out appropriate chunks if any GP dares to treat me with contempt and anger again, which was the reaction couple of years ago when I was RIGHT.

[Triciatextiles]

This is interesting NBob - I wonder where it covers a doctor colluding with other medical professionals and writing in a childs (aged 15) medical notes that the mother is basically making up all the difficulities her daughter has - but surprise surprise the mother now has a diagonositc report stating that her daughter has autism! - yep thats me the mother - its taken 15 years to get this and there is no way I going to let them get away with this.