Dealing with a challenging patient

A patient presented to a GP practice without an appointment and demanded to be seen immediately by a doctor. The patient was verbally aggressive, visibly upsetting both reception staff and patients in the waiting room.

In order to calm the situation down, the GP arranged to see the patient straight away. He simply wanted a repeat prescription of his anti-hypertensive medication as he had a limited amount left and was going on holiday that day. The consultation passed without further incident.

Two weeks later, the GP rang our advice line following a meeting with the other doctors at the practice and the practice manager. Due to the patient's unreasonable behaviour they intended to remove him from their practice list. The practice had a zero tolerance policy, but the GP was concerned to know whether the removal was appropriate under the circumstances.

Our advice 

The GMC acknowledges that there are rare circumstances when the trust between a patient and their doctor may break down and it becomes necessary to consider whether the breakdown in the relationship is sufficient to warrant the patient's removal. The GMC goes on to say that a doctor must be satisfied that the decision is fair and must make prompt and appropriate arrangements for the patient's continuing medical care. 

In addition to this the GP must be mindful of his obligations under the National Health Service (General Medical Services) regulations, which require the practice to give 12 months written warning of the intention to remove the patient from the practice list unless it is, in the practice's opinion, not reasonable or practical to do so. 

The MDU adviser asked if the patient had behaved in this way before or if there was any reason, such as a mental health problem, which may have led him to behave so aggressively. If so, had he been warned about inappropriate behaviour during the last 12 months? 

The adviser suggested that at this point it may be more appropriate to write to the patient warning him that further behaviour of that nature would not be tolerated and could result in him being asked to leave the practice.

The GP was advised to keep a record of the incident and ask the members of staff who had been involved to provide factual statements, and to keep this information in a file separate to the clinical record. 

Outcome

In this case, the practice decided to offer a warning to the patient. The patient apologised for his behaviour and explained that there had been personal circumstances which had led him to act in this way. The GP felt that this had restored the doctor-patient relationship and it was no longer necessary to consider removing the patient from the practice list.

This article originally appeared in the printed Good Practice June 2014 issue entitled "Challenging patient"

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This page was correct at publication on . Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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