The Dilemma: You regularly attend a nursing home. The patients are well looked after, but several have embarrassing conditions such as urinary incontinence and haemorrhoids. You do not always have to examine them, but when you attend you are expected to speak to patients in the lounge despite the lack of privacy. You repeatedly ask the staff about seeing patients in their own room, where you can discuss their problems in private. The manager steadfastly refuses, saying there is not the time, the staff or the space to arrange for your visits in this way. You feel your patients deserve better.
What should you do?
A GP's response - Dr Alison Glenesk is a GP trainer in Aberdeen
This is clearly a worrying situation. First I would speak to the manager. They should be well aware of the necessity to maintain patients' privacy and dignity. There may be problems within the nursing home causing stress and affecting professionalism. They may admit they are having difficulty coping.
It would also be sensible to get a feel for the attitudes of other staff. If they reflect the attitudes of their boss, there is a major problem. If I was unable to establish a rapport with the manager, I would become suspicious that there was some reason they did not wish the patients to be examined.
Though most nursing homes are exemplary, there have been reports of neglect or even abuse of elderly residents. I would insist on following normal procedure, for example examining patients in the privacy of their own rooms to rule this out.
If I was unable to resolve the situation, I would contact the manager's superior, usually the local authority or director if the home is private, who has a duty to take action.
A GMC response - Jane O'Brien is head of standards at the GMC
Our guidance, Good Medical Practice, says GPs must respect their patients' dignity and confidentiality. Patients may be embarrassed if consultations can be overheard, and may not be open with their doctors. This can compromise the standard of care they receive, and put them at unnecessary risk.
The standards set by the Care Quality Commission (CQC) require the nursing home to respect their clients' privacy and dignity. Additionally, both the nursing home and the GP have a legal duty to make 'reasonable adjustments' to ensure that the standard of care for people with disabilities is as close as possible to the standard provided to other patients.
The GP could remind the nursing home manager about the standards set by their regulator and the law, and suggest working together to find a solution. Perhaps the GP could arrange to see residents at a time of the day when they are usually in their room.
If this approach does not work, the GP should consider raising the issue with the relevant regulator. Before taking such a step they should seek advice from an experienced colleague or medical defence organisation, and they should always record the steps they have taken and advice they have sought.
A patient's opinion - Elizabeth Brain is an expert patient
A private environment is an essential prerequisite for the patient to speak to the practitioner without hindrance or embarrassment.
The current situation is intolerable and cannot be allowed to persist. Effective management of a patient's needs will not only hasten an improvement in their quality of life but will also lessen the overall demands on the nursing home staff.
You should request, and if necessary insist on, a meeting with the manager. If the manager does not agree you should say that a lack of privacy and dignity is contrary to the required standards of the CQC. If they still disagree, you should say that you will immediately report them to the CQC.
If they agree, you should explain that you cannot fulfil your duties to your patients unless they are offered privacy during your consultations.
You should remind them that the current situation is preventing your patients from getting the treatment that they deserve and that it is unnecessarily degrading their quality of life.
Finally, you should leave them in no doubt of CQC requirements and that if staff continue to be prevented from escorting your patients to an appropriate location, you will report them to the medical authorities.