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GPs' swine flu pandemic dilemmas

Sarah Whitehouse and Dr Roger Palmer provide the answers to some common ethical questions for GPs.

Doctors are expected to protect their own health through vaccination
Doctors are expected to protect their own health through vaccination

Q. I am concerned with the safety aspects of the swine flu vaccine and may refuse the vaccination. Should I deter my patients from having it?

As the European Medicines Agency (EMEA) has approved the vaccines, it is extremely unlikely that they will be unsafe.

The vaccination programme will get underway when vaccine stocks are available - probably by the time you read this.

All NHS organisations must develop plans to vaccinate eligible frontline staff, who will generally be expected to have the vaccine. As a doctor, you have a professional obligation to provide treatment in a patient's best interests, and you should not press your personal views on a patient.

However, if you have concerns about any form of treatment, the GMC in its revised Good Medical Practice: responsibilities of a doctor in a national pandemic, states: 'If carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell them they have the right to see another doctor.'

As well as explaining this, you must ensure that the patient has the correct information they need to access to treatment from another GP.

Q. Which groups of patients must have priority for vaccination?

The DoH advises that the swine flu vaccination programme will be targeted at the following groups in the first instance:

  • Individuals aged six months and up to 65 years in the current seasonal flu vaccine clinical at-risk groups.
  • All pregnant women.
  • Household contacts of immunocompromised individuals.
  • People aged 65 and over in the current seasonal flu vaccine clinical at-risk groups.

You should not treat members of your own family or individuals with whom you have a close personal relationship, or prescribe for them.

Q. How should we allocate practice resources in the event of a swine flu pandemic?

According to the RCGP's guidance Preparing for a pandemic influenza: guidance for GP practices, to minimise the spread of the swine flu virus, patients with it should be isolated wherever possible, stay at home and self-care.

The exception to this is that around one-third of symptomatic patients, including all children under one year of age, will require assessment or treatment from a GP.

This also includes the elderly and those with under-lying health problems.

In Good Medical Practice, the GMC states that clinical decisions should be made 'in relation to the provision of care and based on clinical need and on the patient's capacity to benefit, and not simply on grounds of age, race, social status or other factors which may introduce discriminatory access to care'.

Q. What about my own health, and that of my dependents, if I have to treat a patient who has swine flu?

As a doctor you have a professional obligation and a duty of care to treat all of your patients, and patient care must be your primary concern.

The GMC, in its revised Good Medical Practice, states that 'you must not refuse to treat a patient because their medical condition might put you at risk'.

You should follow Health Protection Agency (HPA) advice about wearing protective clothing. See its Pandemic (H1N1) 2009 influenza: personal protective equipment guidance, which states that facemask, plastic apron and gloves should be worn if treating probable and confirmed cases of H1N1.

Visit its website for details of when additional protective equipment may be necessary.

Each primary care organisation should have arrangements for minimising the risk to doctors who are pregnant, have respiratory conditions, or who care for dependent children or sick or elderly relatives.

However, in a pandemic there may be staff shortages, in which case all doctors have a professional obligation to prioritise the needs of their patients.

Q. One of my GP colleagues at the practice looks exhausted and keeps making simple errors. What should I do?

You must always protect patients from risk of harm posed by a colleague's conduct, performance or health. You should speak to the colleague concerned.

If you remain concerned give an honest explanation to an appropriate person such as your PCT's clinical governance lead.

The GMC's revised Good Medical Practice takes into account that doctors may be asked to work longer hours in a national pandemic, and will need to balance the risks that may be introduced by fatigue against the alternative of patients receiving no care.

  • Sarah Whitehouse is a writer and Dr Roger Palmer, a medico-legal adviser, at the Medical Protection Society, www.medicalprotection.org

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