A problem shared - Crossing professional boundaries

Three GP registrars describe how they would handle a situation when a dinner date wants to be a patient.

Ask the receptionist to find out as much as possible about the nature of the appointment (Photograph: Istock)

The problem
As a young, single GP you are socialising with friends one night and happen to meet a pleasant group of young people. One of the group invites you out for dinner later in the week. During the evening, you discuss work and mention your job as a GP. A week later you are at work and note that the dinner date is booked as your next patient. The appointment is booked as a routine slot, with 'personal' noted in the details column. What do you do?

Dr Kay Snowdon's view
This poses the problem of crossing professional boundaries. The 'personal' comment, which has been added to the notes, conjures some uncertainty as to the professional nature of the consultation.

There are a number of options which could be used to deal with the situation and it is a matter of professional judgment as to which is taken.

The patient could be seen, as per the booked appointment. This would give the patient the opportunity to discuss the reason for making the appointment.

It would also give the doctor the opportunity to explain the importance of keeping personal and professional matters separate.

Accurate documentation of the consultation is essential. If the doctor felt uneasy about the consultation taking place a colleague could be asked to see the patient.

The situation needs to be dealt with at the time, but if concern remains then suggested avenues for support include work colleagues, the medical defence bodies, the BMA and the GMC standards and ethics team.

The GMC provides guidance which states that 'you must not use your professional position to establish or pursue a sexual or improper emotional relationship with a patient or someone close to them'.

The doctor has a duty to the general public to maintain professional integrity and behave in a respectful manner.

  • Dr Snowdon is a GP registrar in Northumbria

Dr Syed Haque's view
The GMC guidance Maintaining Boundaries deals with this clearly. I am sure the GMC guidance will explain in fine detail why this is not a good idea.

I would not call the dinner date in as the next patient. I would try to find out as much as I could from the receptionist as to the nature of the appointment. If there were no further information available, I would ask to see the dinner date at reception and suggest it would be in their best interest for themto see another doctor.

If they were insistent on seeing you, I would explain that doing so puts you in a professional quandary and offer arrange for them to see another doctor. Remain firm that you are unable to treat them.

It would be best to discuss the patient at the next practice meeting if you were to pursue the relationship in order to avoid this situation recurring.

  • Dr Haque is a GP registrar in East Anglia

Dr Hamed Khan's view
This scenario is very possible, especially if you live locally to your practice. My response would unambiguously be to ask another GP to see the patient.

The GMC's Good Medical Practice states clearly that: 'Wherever possible, you should avoid providing medical care to anyone with whom you have a close personal relationship.' A 'close personal relationship' is broad enough to include family members, close friends and indeed anyone you meet socially outside work.

There are exceptions where this may not be possible, such as emergencies outside a hospital or practice setting where you are the only medically qualified person capable of providing life saving treatment.

It could also apply to a single-handed GP working in a sparsely populated rural area, where there may be no other GP within a commutable distance.

In any case, it would still be prudent to consult your defence union first.

There are a number of potential problems associated with treating friends, relatives or other social contacts. Any emotional attachment you have may hinder your judgment and analytical ability.

It may also deter the patient from giving you a full history. You also make yourself vulnerable to allegations by the patient, who could potentially accuse you of unfairly taking advantage of your professional authority in interactions outside the practice setting.

As a trainee, your first port of call for advice should always be your trainer. In most cases the sensible option would be for another doctor to see the patient, and for you to explain to the patient that your professional regulatory body (the GMC) does not allow you to provide care for people who you know.

  • Dr Khan is a GP registrar in London
Next problem

A 60-year-old patient has been to see you appropriately three times over the past two months with regards to management of gout. Each time the patient consults with you they bring you a present of chocolate. How do you approach this constant gift giving with the patient? Should you have discussed it before now?

Email GPeducation@haymarket.com with your replies by 10 December 2010. We will pay £25 for each reply published.

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