Practice dilemma: Should you intervene in the care of another GP's patient?

The care of a personal acquaintance may be lacking. Should you become involved?

The dilemma

Your mother has told you that her friend Clare recently saw her GP. She had coughed up a lot of blood over the weekend and was understandably worried. Clare told your mum there were 'pieces of liver' in the blood. Clare is usually very fit and well and is not on any regular medications. She is 72 years old and a non-smoker. Clare also told your mother that over the past few months, she has been feeling a bit more tired than usual.

Her GP examined Clare by listening to her chest and reassured her, explaining that the blood she coughed up was due to a burst blood vessel and no further tests were needed.

You are surprised by this course of action, because you believe that if Clare were your patient, you would refer her for further investigations. Should you intervene and explain this to Clare or your mother?

A GP's response

Dr Raj Thakkar is a GP in Wooburn Green, Buckinghamshire
This is a situation we could all face. It is important to bear in mind that the truth may have become distorted and information lost in translation, namely that the GP is indeed organising further tests.

This being a possibility, it may be worth confirming the facts with Clare and if they are accurate, suggesting she sees her GP as soon as possible to discuss these concerns.

Honesty and transparency are the best policy and in line with best practice. Clare should feel enabled to mention where these queries originated. If her concerns are not resolved, she could see a different GP in the practice, or change practices.

Let us assume the story is accurate and her GP did not organise further tests. The safety of other patients this doctor treats may or may not be called into question. With such limited information, a heavy-handed approach seems counterintuitive and in any case, it would not be up to you to investigate.

However, you should not ignore the situation. Options at this stage could be to discuss the matter with the GP in a non-confrontational manner, although this does not help other patients if they have been mismanaged and is arguably too direct.

You might discuss the case with a senior partner at your own practice, seek advice from the LMC or talk to the medical director of the local area team.

It may be that the GP's practice or the area team already have concerns and are gathering evidence. Either way, patient safety must override the discomfort of whistleblowing.

A medico-legal opinion

Dr Zaid Al-Najjar is a medico-legal adviser at the Medical Protection Society
This scenario will be familiar to most doctors. It is always awkward being asked for a second opinion on an informal basis by a family member, a friend or someone you happen to meet socially.

I often find myself surprised when I hear some of the advice relayed to people by their regular doctors and I have to remind myself this may not be the whole story.

Many doctors will also have been on the other end of this scenario, seeing a patient who expresses strong opinions about what they require in terms of treatment, following advice they have received from a medical friend or colleague, which may not be in line with yours.

The GMC's Good Medical Practice states: 'You must treat colleagues fairly and with respect ... You must, wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship.'1

Clare may not be someone you consider you have close ties with, but providing medical advice can be construed as clinical care.

It is important to bear in mind that you do not know the complete clinical history or the details of the consultation that occurred. Patients can, and do, misinterpret or forget parts of consultations.

In this scenario, the GP, in addition to reassuring the patient that no further tests were needed, may also have referred her to a specialist.

Clearly the symptoms are alarming, but rather than criticise the clinical management, it is more appropriate to empathise that the patient's symptoms sound very unpleasant and serious, and suggest that if they have not cleared up, they should go back to their GP for further advice as soon as possible.

If they are unhappy with the advice given by one of the GPs at the practice, others will usually be available to provide a second opinion.

A patient's opinion

Danny Daniels is an expert patient
Although you disagree with Clare's GP about the decision not to investigate further, it would be prudent to pause and reflect before embarking on any course of action that might call your own professionalism into question.

It would be imprudent to make judgments based on anecdotal evidence. You have no knowledge of Clare's history. You do not know if she or your mother have presented the facts and, more importantly, you were not at the consultation.

Equally, you are ignorant of Clare's current state of health. She may have recovered and be unaware that you are concerned about her.

If despite this, you feel you must intervene, it would be prudent to discuss the matter with a senior partner or colleague before doing so. The GMC guidance states that you should not make unfounded criticisms of colleagues that might undermine a patient's trust in their treatment or the judgment of those treating them.

Reference

1. GMC. Good Medical Practice. www.gmc-uk.org/guidance/good_medical_practice.asp

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