Doctors who treat high-profile patients face a unique set of challenges when it comes to ensuring they receive the best possible care. Dr Anthea Martin investigates these issues and offers advice on how doctors can protect themselves, as well as the patient.

In March 2021, Dr Richard Freeman, the former chief doctor to British Cycling and Team Sky, was erased from the medical register after a hearing at the Medical Practitioners Tribunal Service (MPTS), which concluded that his fitness to practise as a doctor was impaired.

During the hearing Freeman had admitted to or been found guilty of 21 of 22 charges relating to poor record keeping, inappropriate treatment of non-athletes, and, most damningly, a delivery of banned testosterone patches to British Cycling’s Manchester headquarters in 2011.

The tribunal concluded that Freeman had ordered the testosterone “knowing or believing” it was to be given to an athlete, although this is something that Dr Freeman has denied. The MPTS ruled that Dr Freeman’s behaviour was fundamentally incompatible with continued registration.^[1]

Under pressure
Any doctor can be exposed to a medical situation where the easy route would be to acquiesce to a patient’s demands. Most of us can relate to a common scenario involving a patient who presents with a viral sore throat and asks for 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 prescribe antibiotics.

But what would you do in a situation involving a high-profile patient – perhaps a politician or famous singer who is well-known and is due to make an important public speech or appear in concert in two days’ time? Would you feel more pressure to prescribe the antibiotics when your patient is in a position of power or influence and used to getting what they want?

Pressure from third parties can also make it difficult for a doctor to treat high-profile patients. Celebrities or sports professionals could be heavily influenced by their manager, coach, or other individuals with a vested interest in their career. This can pose problems when the decisions they make conflict with what you believe to be in the patients best medical interests. Even worse, you may be asked to do something that is fundamentally unethical and contrary to your patient’s interests and your professional obligations.

From a dispassionate stance, we all know what a doctor in these situations should do, but when under extreme pressure some may feel obliged to succumb to the patient’s, or others’, demands.

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. Your medical judgment should not be swayed by the social status, wealth, or influence of the patient or others. You should only prescribe drugs or treatment when you are satisfied that they serve the patient’s needs and you should only provide treatment based on the best available evidence. In addition, in making decisions about medical care and treatment you must also make sure that your conduct justifies your patient’s trust in you and the public’s trust in the profession.

Confidentiality and record keeping
Confidentiality is central to the trust between doctors and their patients. For doctors who treat famous and high-profile patients, extra reassurance that this right will be respected may be required. Concerns about confidentiality may lead to this type of patient to ask for certain medical conditions not to be recorded in their notes. It is rarely appropriate to omit clinically relevant information from a medical record and this must be explained to the patient.

Your duty to your patient includes ensuring that there is continuity of care and omitting information from the record could mean other healthcare professions are misinformed about their condition. Patients do, however, have the right to ensure that their information is accurate – so they can request that factual inaccuracies in the record are rectified. 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. If you decide that a correction is not warranted, you may 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 an accurate record of their care, for their wellbeing and your protection. Reassure them that they can take comfort in the fact that there are laws and professional obligations to protect against disclosure against their wishes to ensure their need for confidentiality is respected.

Indemnity
While as doctors, we are likely to be only too aware of the implications of possible treatments on patients and the risk of and impact of an adverse outcome, this is a very important aspect that needs to be considered when treating high-profile patients when they present with problems relating to their particular talent – particularly those with a high net worth or value.

Although adverse complications would be distressing for any patient, the potential loss of earnings of a high-worth individual could mean that a high-value claim is brought against you. It is therefore important when treating patients of this type that you ensure you have appropriate indemnity in place.

In 2005, a claim was brought against an orthopaedic surgeon after treating a Premier League footballer who had sustained a knee injury while training. The football club’s doctor referred the patient to the surgeon for treatment but, unfortunately, the player did not resume a level of fitness to return to professional football. The club brought a claim against the surgeon, alleging negligence, and breach of contract.

The value of the claim was substantial and included the loss of the player’s value on the transfer market, and the cost of buying a replacement player. Medical Protection, on behalf of the surgeon, disputed that although he owed a duty of care to the patient, this duty was not extended to the club as a whole, either on a contractual or implied basis. The High Court ruled in favour of the surgeon – a decision that was also upheld on appeal.

This case illustrates the importance of making sure you have appropriate indemnity in place when treating patients with a high net worth or value. It also highlights the importance of not entering into contractual obligations with a third party – for example, sports clubs, TV studios, or record labels – without first understanding what indemnity arrangements are in place or expected. In view of the case highlighted, you may also wish to ensure that any fee notes are addressed directly to the patient and not a third party.

Doctors who may be treating elite/professional sports people or other high-net-worth individuals as part of their routine practice should contact their indemnity organisation to ensure they are adequately protected.

^[1] https://www.theguardian.com/sport/2021/mar/19/former-british-cycling-and-team-sky-chief-doctor-richard-freeman-struck-off