dileMMAS
dilemma 2. Medical requests outside the surgery
You’re walking your children the patient and taking
to the school gates, when Mrs account of a full history?
Jones, accompanied by her twin
■
Can you fully assess a
boys Peter and Simon, stop to patient in this context, ie,
say hello. You’re quite friendly examine them, take a full
with Mrs Jones and have treated history, in a public setting?
her children over the years while
■
Can you arrange further
locuming at the local practice. investigations or treatment
You begin a general conversation where necessary?
with her. She begins discussing
■
Can you refer the patient
her sons and says: “It’s quite to another practitioner
coincidental that I’ve seen you for follow-up?
actually, because I was going
■
Can you record your findings
to book an appointment with a in the medical records?
doctor as soon as I got home. Doctor–patient relationships are
Will you save me the bother?” effective because a professional
She goes on to describe boundary exists between doctor
the symptoms of a recurring and patient. Discussing a
problem Peter is experiencing. general problem outside surgery
Do you listen attentively and may breach this boundary and
share your medical opinion? undermine the trust that is so
crucial to the relationship.
A medicolegal opinion In the case of Mrs Jones,
Initially you may be happy to you should adopt an empathic
give someone general advice approach and explain why it
about a problem; however, it is would be better for her to make
worth bearing in mind that to that appointment and see a GP
do so might engender a claim if at the surgery. Stress that you
something went wrong. would not be able to properly
Y
The GMC does not offer diagnose her son’s condition
r
a
r
advice on dealing with informal without being able to review
B
l
i
consultations. However, his medical notes or conduct t
o
o
there are some general the necessary examination or
H
e
p
questions to consider: tests. If she persists, add that
c
■
Can you deliver good clinical to offer advice with incomplete
i
e
n
c
care, by adequately assessing information may cause a serious
l
/
s
the conditions, examining problem to be missed.
i
e
d

r
n
t
i
r
a

M
dilemma 3. requests for references
an acquaintance, who you have also seen as a patient at another surgery, sees you when you’re shopping in
town. He asks if you could write him a character reference for a new job. although as an acquaintance you
would have no qualms about doing this, as a gp, you are aware of his previous history of depression. What do
you do?
A medicolegal opinion
in this dilemma the problems encountered would be similar to those in dilemma 2. How do you manage an
informal consultation? You may not see a problem with writing the reference, and may be happy to do it, but if
something went wrong you would be liable.
in this dilemma you are in an awkward position. it would be best to explain that, as you have seen him in
surgery, you would not be the best person to provide a reference of the type he is requesting.
eriKa craddocK/sciencepHotoliBrarY
sessional gp | voluMe 1 | 2009 www.mps.org.uk 27
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