PRACTICE MANAGEMENT: UNREASONABLE BEHAVIOUR


BACKGROUND: An 81-year-old man, Mr G, is deaf and has a history of heart disease and diabetes. His son Mr CG holds power of attorney for his father. When Mr G becomes unwell, suffering stomach pains and nausea, his GP Dr N agrees to make a home visit. An examination of his abdomen reveals no abnormality so Dr N prescribes medication to alleviate the symptoms and arranges for a follow-up examination at the practice. A few days later Mr CG comes into the


practice to speak to Dr N and they disagree about Mr G’s condition and the recommended treatment plan. Mr CG becomes angry and raises his voice, insulting Dr N and threatening to make a complaint about her to the GMC. Dr N contacts Mr CG to speak to him about his behaviour but he is again verbally abusive. Dr N reports this to the practice’s senior partner who decides to take steps to remove Mr G from the practice list due to his son’s unacceptable behaviour. The practice tells the PCT about the decision and Mr G is also informed in a letter from the senior partner that explains the decision and includes information on registering with an alternative practice. One week later, Dr N receives notice from the


from a patient or carer. The adviser recommends the practice


provides evidence of their compliance with the GMC’s Good Medical Practiceguidance by including a copy of the senior partner’s letters to Mr G and the PCT. On the basis of this response, the GMC concludes that the practice was justified in removing Mr G and recommends the case is closed.


KEY POINTS


GMC of a complaint made against her by Mr CG alleging Mr G was removed from the list without a valid reason.


ANALYSIS/OUTCOME: Dr N contacts MDDUS and a medico-legal adviser helps her draft a response to the GMC. She is advised to highlight the fact that Mr CG’s complaint had already been appropriately handled by the senior partner. She is also advised to explain that the practice’s decision to remove Mr G was in accordance with their policy regarding abusive and aggressive behaviour


● Removal from a practice list is justified only in cases where the doctor/patient relationship has broken down – for example, if the patient has acted unreasonably or been violent to you or a colleague.


● Be prepared to justify a decision to remove a patient and inform the patient,


in writing where practical. Removal without first informing the patient in writing should only be done where there is real, or a threat of, violence to doctors/staff.


● Always follow GMC guidance detailed in Good Medical Practiceparagraphs 38-


40. Refer to RCGP’s 2004 guidance at www.tinyurl.com/3kkbmxv


CONSENT: PRESUME NOTHING


BACKGROUND: Mr H attends his dental surgery complaining of poor fitting partial dentures that cause him difficulty when eating. He also has a small number of remaining teeth that have been causing him some discomfort. His dentist, Mrs C, finds they are in poor condition and advises the removal of all four remaining teeth and the fitting of complete dentures. Mr H agrees to have one tooth extracted but does not want to lose all of them. Mrs C proceeds to remove all four of Mr H’s teeth. The existing partial denture, with the four teeth added, is then fitted. Following the treatment, Mr H suffers bleeding, pain and discomfort and is prescribed analgesics and antibiotics by another dentist. He is forced to take a week’s sick leave from work. Mrs C is the subject of a complaint to


AUTUMN 2011


the GDC regarding her treatment of Mr H and is found guilty of serious professional misconduct for not securing informed consent to remove his teeth and for failing to provide adequate post operative care. Mr H then raises a claim against Mrs C alleging that she extracted four of his teeth without his consent and that Mrs C proceeded with the extractions against his wishes.


ANALYSIS/OUTCOME: Mrs C contacts MDDUS for assistance and it is decided that, in light of the GDC finding, it would not be possible to fully defend the claim. It is also noted that Mrs C failed to make a comprehensive record


of Mr H’s treatment, making it difficult to know what was discussed and agreed with the patient. Based on the poor condition of the extracted teeth, MDDUS negotiates a modest settlement with Mr H’s solicitors.


KEY POINTS


● Always fully explain treatment options and ensure the patient understands the relevant risks/benefits involved.


● Never proceed until you have confirmed with the patient exactly


what treatment is to be carried out.


● Take comprehensive notes which specify treatment options discussed with the patient and details of consent given.


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