Treating high-profile patients: What are the medicolegal challenges?

While treating high-profile patients may not be an everyday occurrence, these encounters can often pose unique medicolegal challenges. It is useful for doctors to be aware of these challenges and the steps they can take to safeguard themselves and their patients.

Consider a scenario where a patient may present with a viral sore throat and insists on a course of antibiotics. With an ‘everyday patient’, the typical approach is to recommend symptomatic treatment rather than antibiotics.

However, how would you respond when faced with high-profile patients, such as celebrities, who may be accustomed to having their demands met? Is it tempting to prescribe antibiotics to appease their wishes?

From a medicolegal perspective, it is crucial to emphasize that your medical judgement should remain impartial, unaffected by the social status, wealth, or influence of the patient you are treating. As a doctor, your primary duty is to provide care to all patients, irrespective of their identity. Your foremost concern should be their medical condition and what you can do, within your professional capacity, to offer appropriate assistance.

Confidentiality
Open any entertainment magazine and you will find examples of celebrities’ personal health. 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 instill 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 continuity of care, and omitting information from the record could mean other healthcare professions are misinformed about their condition.

Even the most demanding of patients should understand that it is your professional obligation to keep a record of their care, for their well-being and yours. Reassure them that they can take comfort in the fact that there are laws to protect against disclosure against their wishes, while also ensuring 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 and the options, and tell them what the worst-case scenario would be if the patient were to refuse the advice. Except in emergency situations, you cannot enforce any treatment without the patient’s consent. Equally, you should not 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 in any discussion and explain that this would be considered 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, a doctor also needs to take particular care in discussing and considering the patients’ individual needs and circumstances. For example, would a possible treatment impact their career or talent?

Imagine the patient is a well-known singer presenting with increasing hoarseness and an otorhinolaryngologist confirms polyps on the vocal chords. Should you fail to warn the patient about the possible complications or discuss the options available, you leave yourself open to criticism if something were to go 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 amount than in the case of a patient who does not rely on his/her voice to make a living. Such a claim may also be high profile with the risk of reputational damage.

Maintaining standards
When faced with treating a high-profile patient, many doctors react in different ways. Some will be nervous, worried that the patient could ask them to go outside the boundaries of what they consider to be best practice. 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 the patient’s 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 if you require advice, always contact your medical defence organization.