A GP who ran internet consultations for patients was last week suspended for nine months by the GMC for irresponsible prescribing.
Julian Eden was found to have acted irresponsibly, or not in the patient's best interests, in the cases of three patients and two undercover journalists who applied for prescriptions to his website, e-med (http://e-med.co.uk).
The most serious case, the GMC panel found, was that of a teenage boy, referred to as Patient A, who acknowledged in his online application that he was prone to self harm, smoked cannabis, entertained suicidal thoughts, and was inw the care of child psychiatric services. Despite this Dr Eden gave him repeat prescriptions of propranolol without a face to face consultation. Patient A eventually overdosed on the drug, but he survived.
Dr Eden admitted irresponsible conduct in his prescribing to two other patients, who both became addicted. Patient X, a Swansea businessman, received 43 monthly prescriptions for the sleeping pill zolpidem over a 26 month period. Eventually he took to forging the prescriptions to save the consultation fee, until he was caught by police.
Fiona Hutson, the only patient named in the case, was able to obtain diazepam and dihydrocodeine from Dr Eden for a year without ever seeing him for a consultation in person.
Both patients testified that they had misled Dr Eden to obtain extra drugs. Patient X would claim to have lost prescriptions and asked two friends to sign up to the e-med service. Mrs Hutson said she had been “devious” in finding ways to refill her prescriptions early, for example by claiming that she was going on holiday and needed a longer supply. Dr Eden did not verify whether the prescriptions had been filled at a pharmacy.
Alan Jenkins QC, representing Mr Eden, said his client was guilty of “an element of naivety” but noted that Mrs Hutson had been given larger doses by her own GP.
Dr Eden was also found to have prescribed drugs to two newspaper journalists posing as patients: Oliver Harvey of the Sun and Severin Carrell of the Independent. Mr Harvey was initially denied the slimming drug sibutramine (Reductil) because his body mass index was normal but got a prescription after altering his weight on the internet consultation form. Mr Carrell obtained a prescription for sildenafil (Viagra) after going online for two minutes.
Dr Eden told the GMC's fitness to practise panel that available guidance was limited when he set up his medical website. But the panel's chairman, Richard Kyle, told him: “You, as a treating general practitioner, were familiar with the guidance issued by the GMC, which states that good clinical care must include an adequate assessment of the patient's condition, based on the history and symptoms, and if necessary an appropriate examination. It also makes clear that repeat prescriptions should only be issued where you have adequate knowledge of the patient's health and medical needs. By your own admissions, you did not.”
Mr Kyle said the GMC was not against new technology but wanted it applied safely. Doctors should always be cautious when prescribing addictive drugs without a personal consultation, he said. Dr Eden told the hearing that his e-med website no longer prescribed sleeping pills or painkillers.
Dr Eden became the first British GP to offer prescriptions over the internet in February 2000. He was featured that year in a BBC interview, explaining that he started the service because “the NHS does not work for young people.” He told the BBC that his consultations were “perhaps safer than a lot of other consultations in that the response I give is by email and is legally binding.”
At the time the BMA called for tighter controls on internet prescribing. Paul Cundy, chairman of the BMA's information technology committee, said the government was being “astoundingly naive” and leaving patients “at the mercy of internet doctors.”