The husband of a patient voices his disappointment in the local hospital. He would like you to speak with the ward to ensure his wife is given a single room and her food improved. He wonders if you need to visit her to confirm his observations. What should you do?
Dr Barney Tinsley's view
This is a surprisingly common problem for GPs.
I do not think GPs are directly responsible for making complaints to the specific hospital ward; however they may be useful as a conduit to help the husband find the correct individuals to approach.
In this instance, the husband should be given the chance to talk to the senior sister on the ward, and the ward manager, who will be able to implement any changes deemed necessary after a balanced discussion.
The patient's husband should be made aware that the allocation of single rooms depends on many factors including the nature of diagnosis/prognosis and risk of infection.
Food is an issue hospitals take very seriously. Many have staff employed to receive feedback about menus, and try to implement change on an individual and more general level. The ward manager would be able facilitate such a meeting. The husband should be advi-sed that bringing food from home carries potential for infection risk.
The fact that his wife is in hospital might make the husband anxious and under great stress, especially if there is a serious diagnosis. Any concerns and anxieties should be explored and addressed as they may be the root cause of 'blaming' the hospital.
Action should be taken early, so the prospect of simmering resentment, or drawn-out and time-consuming letters and meetings can be avoided.
Dr Tinsley is a salaried GP in Bradford. He qualified as a GP in August 2005
Dr Sadath Ali Khan's view
This situation needs tactful handling. There are issues of patient confidentiality and patients' and carers' concerns about local hospitals, as well as their expectations of their GPs.
It is important to listen to the husband with empathy and patience, because carers of ill patients can suffer stress and anxiety. It is important to elicit his specific concerns and what the hospital has told him about his wife's medical condition, apart from his disappointment with the food and room.
Having established a clearer understanding of his disappointment, I would advise him about the patient advice and liaison service (PALS), Citizen's Advice Bureau and the hospital complaints procedure.
I would make it clear that I could not speak to the ward about providing a single room as it would be unfair to other patients and that it is unreasonable to ask me to visit the hospital to confirm his observation.
However, at the same time I would explain that I would be happy to speak to his wife's consultant if he has concerns regarding her medical care. It would be helpful to remind him that while patients are in hospital the consultant in charge is responsible for their care.
Looking at the bigger picture, if many patients have raised concerns about the local hospital I would discuss this issue in the practice meeting and, with other GP colleagues in the area, write to the medical director or chairman of the hospital trust regarding patients' concerns.
Dr Khan is a salaried GP in Birmingham. He qualified as a GP in 2006
Dr Kamilla Porter's view
My instincts would be to avoid getting embroiled in a potentially hostile situation between this patient's husband and the local hospital.
However, it is important to remember the role of the GP as the patient's advocate. My response would be influenced by previous dealings with the couple and knowledge about the dynamics of their relationship.
For example, is this man a domineering husband who is known to complain frequently or is he simply a considerate, caring person appropriately concerned about his wife? In the first instance I would listen sympathetically to his account and try to establish if his wife shares his frustrations.
If his concerns sound quite reasonable I might consider asking his permission to discuss this matter with his wife in hospital to find out her opinion. While acknowledging the reasons for his wish to have a single room, I would explain there may be clinical reasons why this would not be appropriate and that side rooms are limited and frequently used for infection control or special cases such as patients who are terminally ill.
Before taking further action I would have to consider my agenda as a busy GP; it is likely to be difficult to find the time to make a visit to the hospital. Furthermore, I could end up antagonising and undermining the hospital staff, making the situation worse for the patient and diminishing my reputation.
I would explain to the husband that it may not be helpful for me to get involved and that my influence is likely to be limited. Instead, I would suggest that he makes an appointment to see the ward sister or even the consultant to discuss matters.
If I were alarmed by what was being said about the standard of care I would consider telephoning the consultant to discuss my concerns.
In summary, I would encourage the husband to try to resolve this matter firstly with the ward staff and clinicians and, if that fails, advise him to follow the hospital's formal complaints procedure.
I would also make an effort to find out the outcome and consider making a follow-up phone call to the patient or her husband.
Dr Porter is a GP in Tenterden, Kent. She qualified as a GP in 2004
A patient of yours has been diagnosed with a rare, progressive neurological condition. As a result she attends almost weekly and calls you frequently with any concerns about possible new related symptoms. She says you are a lot more supportive than any of the other doctors in the surgery have been even since before her diagnosis. She seems unaware that she is taking a lot of your time. What do you do?
Email: GPeducation@haymarket.com with your replies by 30 April 2008. We will pay £25 for each reply published.