8 Mar 2005 - Recomended Reading
MAY BE REPOSTED
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
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