Prescribing without access to patient records

Background

Aoife is working away from home for six months and is not registered with a GP in the local community. She contacts an independent online health company complaining of severe back pain and asks to be prescribed Fentanyl, which is a controlled drug (Misuse of Drugs Act 1971 and Misuse of Drugs Regulations 2001).

Scenario

Dr Hafeez is an independent doctor working for the online provider. He doesn’t have access to Aoife’s medical records and asks for consent to contact her local GP. Aoife says she can’t remember the details for her GP and also has concerns about sharing such personal information with a commercial company.

What should the doctor do?

  • Prescribe the six-month supply of Fentanyl given the sensitive situation.
  • Refuse to provide treatment and signpost to other services.
  • Offer a limited dose to provide continuity of care for a short period until it’s possible for him to access patient records, or for Aoife to temporarily register with a local GP.

What the doctor did

Dr Hafeez tells Aoife he can’t prescribe painkillers without access to her medical records because it would be unsafe. He patiently explains why it’s important to share information. He tries again to persuade Aoife to give consent for him to contact other healthcare staff involved in her care, so he can verify her identity and confirm information about her medical history. 

Aoife gives consent for the doctor to contact her GP. As a result, Dr Hafeez discovers there is a concern relating to patterns of prescribing and self-harm, so he decides not to prescribe.

What the doctor had to consider

  • Does he have enough information about Aoife’s health condition to safely prescribe? (for example, access to medical records, need for physical examination)
  • How much does he know about other medication she is taking?
  • What is the risk of harm from prescribing medicines liable to misuse, overuse and abuse?