The dilemma: You have received a number of letters from a patient that included derogatory remarks about you. The most recent one was in the form of a handwritten note left under the windscreen wiper of your car. The note was a follow-up from a complaint made by the patient, which has been fully addressed by the practice.
There are a number of issues in the aforementioned scenario:
- The patient is perpetuating a complaint which has already been addressed by your practice
- The patient is making personal comments about you
- The patient has now left a note on your car, visible to members of the public
Firstly, if the practice is satisfied that it has addressed all elements of the complaint to the best of its ability, it should direct the patient to the Parliamentary & Health Service Ombudsman (PHSO) and the local advocacy service in a formal letter. Your practice may inform the patient that they are not obliged to continue the correspondence with them about the stated matter unless a new concern arises.
There is a fine line between a disgruntled patient writing an angry letter and a patient who is a perpetrator of unacceptable behaviour. The practice should consider if that line has been crossed. In this scenario, GMC Good Medical Practice guidance and the Harassment Act 1997 should be considered.
The GMC guidance states that: 'Good doctors make the care of their patient their first concern'. In the type of scenario illustrated, you should ask yourself whether the patient is showing a symptom of a treatable illness.
It is possible that this type of harassment may be a sign of mental health illness. However, a doctor would not be expected to put their own life, or the lives of others in jeopardy in order to meet the care needs of a patient. If there is any element of threat in the correspondence, you should put your safety first.
What is harassment?
Harassment can take different guises but the effects are the same in that the behaviour of the perpetrator causes alarm, distress and/or instils a fear of violence in the victim. The behaviour of the perpetrator would be considered by a reasonable person to be distressing. Therefore, the perpetrator ought to know that their actions would be perceived negatively.
The contact does not have to be abusive in nature to constitute harassment and may take the form of persistent and unwanted declarations of romantic feelings. Stalking is also a form of harassment as it makes the victim feel that their freedom is being curtailed (for example, following, watching, spying or forced contact).
If your patient leaves something or appears at a place which would not be privy to them, including your car location, then it could be an example of stalking.
The next steps
The Royal Society of Psychiatrists guidance on managing stalking advises that you may, in the presence of a colleague, ‘inform the stalker once only and in a clear language that their approaches are unwanted and cause fear and distress.’
Additionally, the advice states that you should then follow up with the stalker in writing; this message should explain the legal consequences if the stalking continues. In some circumstances, it may be more appropriate if the message is delivered by your colleague, manager or a legal representative.
If you feel vulnerable or may be under the threat of violence, it might be better to escalate the matter to the police.
Keeping evidence of notes, recorded phone calls and documenting the behaviour, including names of any witnesses, is also important.
You may consider that the distress caused by the patient’s behaviour constitutes a breakdown of trust and that you wish to remove them from the practice list. If this is the case, it is important that you follow the GMC guidance on the removal of patients from the practice list and, as part of that, ensure that the patient is sent a warning letter.
The warning letter should advise them to stop their behaviour and set out the consequences of not doing so, such as removing them from the practice list.
If you have concerns about harassment due to your professional status, contact your medical defence organisation for further advice.