The MDU receives more requests for assistance with amorous patients from GPs than any other group of doctors.
This may be because patients are likely to become more familiar with their GP than any other doctor and perhaps form an unhealthy attachment.
As a GP, it is important that you are alert to this risk. If a patient behaves inappropriately, take action at the earliest opportunity. It may feel awkward but if the patient's behaviour is unchecked they may think you are condoning it, which could make matters worse as this typical case shows (see box below).
|A 19-year-old girl who had presented with migraines sent the GP registrar a card and a box of chocolates to say thank you for his supportive and caring approach. He thanked her and assured her that this was not necessary, but the gifts did not stop there. |
Several weeks later, the doctor was receiving at least one call a day from the patient and she would regularly wait for him outside the surgery. Eventually, he told the patient not to contact him unless there was a clinical reason. The patient complained to her parents that the doctor had been rude to her and claimed that he had encouraged her to visit him whenever she felt the need to talk.
The parents, without their daughter's permission, complained to the practice that the GP had behaved unprofessionally.
The practice explained that they could not respond to the details of the complaint without their daughter's consent. Both the parents and daughter later moved to another local GP practice.
It may be tempting to dismiss the attentions of a teenager as just a crush, but every situation is different and even the most apparently innocuous examples can lead to a complaint.
In this case, the registrar's best response might have been to speak to the patient when she first began to contact him outside the surgery. He could have advised her, gently but firmly, that his role was as her doctor and politely requested that she did not to call him or contact him outside the surgery.
Such an approach follows the GMC's guidance, Maintaining Boundaries, which states: 'If a patient displays sexualised behaviour, wherever possible treat them politely and considerately and try to re-establish a professional boundary' (paragraph 26).
The GP registrar might also have found it helpful to discuss the situation with a senior colleague, such as his trainer, who might have dealt with similar issues in the past.
In such cases, it might have been possible for another doctor at the practice to take over the patient's care, although the GP registrar might still have had to treat her in an emergency.
The practice manager could have written to the patient asking her not to contact the doctor inappropriately, and suggesting that it would be advisable to consult with other doctors at the surgery in the future.
If the GP registrar was in a position where he had to treat the patient, consideration should be given, with the patient's consent, to having a chaperone present at consultations.
Finally, the GP registrar might have found it helpful to contact his medical defence organisation as soon as he became aware of potential difficulties with the patient.
The MDU, for example, is often contacted by members who find themselves the object of unwanted attention from patients and can offer support and advice, such as the benefit of keeping a log of all calls, letters and gifts.
Removal from the list
If the patient had not removed herself from the practice list but had continued her inappropriate behaviour, consideration could have been given to removing her from the practice list.
Any decision to do so should be the last resort, and would normally be preceded by a warning in the 12 months prior to removal. It must also be compliant with the relevant provisions of the GP's contract with the PCT as well as advice from the GMC and professional bodies.
Bear in mind that rather than put an end to the problem, it could provoke a complaint.
More serious cases
Unfortunately, in rare cases, events may take a more sinister turn and a GP may become concerned about their safety or that of their family.
In cases where you or someone close to you are at immediate risk of harm, you may have no choice but to contact the police.
In these circumstances, you still need to bear in mind the GMC's confidentiality guidance and ensure that any disclosure of patient information is the minimum necessary in order to allow the police to adequately investigate the concerns.
For example, while it may be necessary to pass on the patient's name and address, it may be more difficult to justify disclosing other details about the patient's medical history. Your medical defence organisation will be able to advise on this.
If a prosecution is pursued and a conviction obtained, the court may impose a restraining order when sentencing an offender.
If a doctor is suffering continued harassment, it is also possible for action to be taken under Section 3 of the Protection from Harassment Act 1997, breach of which could amount to a criminal offence.
Section 2 of the Act makes it a criminal offence to engage in a course of conduct amounting to harassment and provides some measure of legal protection.
Legal action can be a double-edged sword, however. While it can often be successful in stopping the harassment, in cases where the injunction is broken the patient can face a custodial sentence, which may merely serve to fuel the aggression.
1. Tell the patient politely but firmly that your role is as their GP and you are not able to form a personal relationship.
2. Keep your practice colleagues and medical defence organisation informed.
3. Keep a log of contacts with the patient.
4. Consider the use of a chaperone during consultations, with the patient's consent.
5. Removing the patient from the practice list should be a last resort.
6. Maintain strict boundaries with all patients.
- Dr Kirkpatrick is a medico-legal adviser for the MDU
- This topic falls under section 1 of the GP curriculum 'Being a GP', www.healthcarerepublic.com/curriculum
- GMC. Confidentiality: Protecting and providing information. 2004
- GMC. Maintaining Boundaries. 2006.