GP Dr S contacted Medical Protection about a complaint from a patient who was frustrated with the practice’s new appointment system. The patient said she was struggling to make an appointment with her preferred GP who was often booked up for a couple of weeks ahead.
Dr S spoke with an adviser from the Medical Protection advisory team, who talked him through the process of handling complaints in the practice. She advised Dr S to acknowledge the complaint within five working days and explained the complaints procedure, directing him to the Medical Protection factsheet A quick guide to complaints. She also gave him guidance on writing the response. The adviser also reviewed the proposed response before it was sent to the patient.
Dr S contacted Medical Protection again several weeks later in relation to a letter he had received from the same patient. She had written to the practice asking for Dr S to be her named GP. The practice manager had shared the letter with the partners as it contained a number of compliments about Dr S. They had discussed the issue at a meeting and were unsure how best to manage the situation.
After a discussion with Medical Protection’s adviser, Dr S decided to agree to be the patient’s named GP as he felt that they had established a good doctor-patient relationship whilst he was managing her complaint and he didn’t feel any of the comments in her letter were of a personal nature.
Several years later, Dr S contacted Medical Protection to request further advice regarding this patient. Dr S explained that he was moving practices due to family reasons and that when the patient had been advised of this, she had emailed him directly to ask where he was going so that she could register there. Dr S was reluctant to continue as her GP and explained that he was moving out of the area; however, the patient was persistent in trying to find out where he was going, to the extent that she tried to obtain this information from other members of staff at the practice.
Understandably Dr S and the practice were finding this situation challenging, particularly as the patient was now refusing to see any other GPs at the practice. After discussing events with Medical Protection, the partners decided to write to the patient explaining that as Dr S was leaving the practice, she was welcome to see an alternative named GP, however the decision was hers to make. The patient was offered a meeting to discuss matters further should she want to do so.
It appeared that the matter had been resolved, as the patient accepted the change in GP and Dr S moved shortly after. However, a few weeks later Dr S saw the patient leaving his new practice and, after making enquiries, he was advised by the practice manager that she had applied to register with them. The practice explained to her that their practice policy was to only enrol patients who lived within a short distance of the practice, as the practice books were closed and there were very few GPs in the area. Dr S was hopeful that would be the end of the matter; unfortunately, he began to receive cards at the practice in which the patient expressed her wish to meet with him. Dr S contacted Medical Protection again at this stage.
The Medical Protection advisory team advised the practice manager to write to the patient and to invite her to present her concerns in writing so that the practice could respond. Regrettably matters escalated and the patient began sending more letters to Dr S, calling the practice continuously to try to speak to him; she was also seen in the car park on a couple of occasions. The patient subsequently visited Dr S at home, twice shouting outside his door at him and his family.
At this stage Medical Protection advised Dr S to speak with the police and consider applying for a trespass order. The Medical Protection adviser assisted the practice to write a strongly worded letter to the patient asking her to cease contact with the practice and Dr S, informing her that they would no longer receive her phone calls or read her correspondence. If she persisted in her behaviour the practice would seek a trespass order.
Outcome
Fortunately, after receiving the correspondence from the practice the patient made no further attempts to contact Dr S.
Learning points and commentary
Medical Protection is frequently contacted by members seeking advice and support about challenging doctor–patient relationships. This may relate to a breakdown in a relationship with a patient due to their behaviour, where a practice is seeking guidance about whether it would be appropriate to disenrol a patient or, as in this case, seeking advice about a patient who may be forming an inappropriate attachment to their GP. Fortunately, not many cases escalate to the extent of the one described above.
If a patient pursues a sexual or improper emotional relationship with you, you should treat them politely and considerately and try to re-establish a professional boundary. In these situations it is important to consider the need for a chaperone to be present in consultations with the patient. If trust has broken down you may find it necessary to end the professional relationship. We advise you to contact Medical Protection for advice to ensure that you do this in a way that minimises your risk.
These can be emotive situations and can put a doctor under a significant degree of stress. It is not always apparent what a patient’s intentions or motivations are, particularly in the earlier stages.