Tuesday, March 08, 2005

Prescriptions for exercise: the medico-legal implications

Today I received an email from an ME sufferer who like me belongs to the 25% ME Group. It contained the following email from Dr Charles Shepherd, Medical Adviser to the ME Association:

----- Original Message -----
From: "Dr Charles Shepherd"


With increasing numbers of patients being prescribed exercise programmes on the NHS, doctors in the UK have once again been issued with guidance by one of their medical defence organisations and the Department of Health (DoH)on the medico legal aspects of some of the common dilemmas they face when making referrals for exercise treatment.

This guidance is particularly important in view of the fact that people with ME/CFS are now being coerced into undertaking various types of graded exercise programmes - sometimes in a form that is totally inappropriate to their clinical situation.

Key points in this new joint guidance include:

1 Doctors should not go against existing General Medical Council guidance on patient referrals, which states:

"Usually you will refer patients to another registered medical practitioner. If this is not the case, you must be satisfied that such health care workers are accountable to a statutory regulatory body, and that a registered medical practitioner, usually a GP, retains overall responsibility for the management of the patient."

One exception in relation to exercise treatment appears to be sports professionals who are on the Register of Exercise Professionals (REP) as this organisation is a DoH recognised body.

2 The DoH has produced a National Quality Assurance Framework on exercise referral programmes. This advises health professionals on what to consider when referring patients to exercise programmes. It also recommends that when patients are referred to fitness instructors, they are members of the Register of Exercise Professionals that are qualified as advanced, Level 3, instructors.

3 Doctors without specialist knowledge of exercise medicine - which will inevitably include most GPs and psychiatrists - should only "recommend" exercise rather than "prescribing" it. This is because referral and prescribing processes carry a greater legal implication and they have very specific meanings in the medical context. For example, if a doctor "prescribes" exercise for a patient who then suffers a heart attack while exercising, the doctor could then face a claim for damages. So exercise programmes have to be "prescribed" with just as much caution as is applied to the use of drugs.

4 When completing forms for supervised exercise programmes, doctors without special expertise should state that they know of no reason why a patient should be unfit to exercise, rather than certifying them as being "fit to exercise".

5 The DoH have also announced that they will be offering three year training courses in exercise medicine to doctors in an attempt to try and avoid some of the medico-legal dilemmas that are clearly associated with this approach to management.

Further Information

Exercise Referral Systems: A National Quality Assurance Framework, Department of Health, 2001. Can be accessed on the DoH website (www.doh.gov.uk)

For details on the Register of Exercise Professionals telephone: 0208 686 6464

Dr Charles Shepherd
Medical Adviser, ME association
8 March 2005


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