CONSENT: CAPACITY TO CONSENT


BACKGROUND: Mr D is a 73-year-old man who was diagnosed with dementia several years ago. His condition has deteriorated in recent months and an application to the court of protection is being considered that would allow decisions about his fi nancial aff airs to be made on his behalf. His GP, Dr H, receives a letter from a


solicitor’s fi rm acting on the patient’s behalf seeking the doctor’s opinion as to his capacity to manage his personal aff airs. The request is accompanied by a consent form signed by Mr D. Considering Mr D’s dementia, Dr H is


unsure if this is valid and if the patient fully understood the implications when signing it. The doctor is reluctant to discuss these concerns with the solicitors for fear of breaching patient confi dentiality. She contacts


MDDUS for advice.


ANALYSIS/OUTCOME: Before responding to the solicitor, Dr H is advised to speak with the patient to assess his capacity to consent to the disclosure of information. His capacity may be impaired but it is possible he is still able to provide valid consent in these circumstances. If Dr H determines the patient lacks suffi cient capacity to consent then, in the absence of a welfare attorney/court appointed deputy, Dr H should discuss the matter with an appropriate relative or close friend. It can be helpful to involve family members in these matters to ensure they are not likely to object, but this should be handled carefully as there may be confl icts of interest. If Mr D is deemed to have suffi cient


COMPLAINTS HANDLING: LUNCHTIME FRACAS


BACKGROUND: A receptionist sits at the front desk of a dental surgery reading a magazine in the last fi ve minutes of an hour-long lunch break, during which time the surgery is closed. A few patients have turned up early and wait outside the locked entrance. One of the patients – Ms A – starts to rap persistently on the glass door. The receptionist goes to the door and unlocks it and Ms A pushes angrily passed her into the surgery. She demands to know why the


surgery is locked when she has an appointment at 2. The practice manager hears shouting and comes out of her offi ce and asks what is the diffi culty. Ms A complains that she came on time for her appointment only to fi nd the door locked and what kind of customer service is that? The PM asks her to calm down and explains that the lunchtime closing is practice policy. Ms A shouts loudly that she “will not calm down” and thrusts two fi ngers in the PM’s face as she rants about the “rude ****ing staff ”. The PM backs away and tells her that the practice does not tolerate such aggressive behaviour and that she will be reporting the incident to the dentist.


AUTUMN 2014


Ms A shouts: “Please do!” Later before treating Ms A the dentist


COMPLAINTS HANDLING: Lunchtime fracas


explains that the offi ce is locked over the lunch period for reasons of staff security. The patient says she was not happy having to “wait outside in the cold”. The dentist replies that this is no excuse for her aggressive behaviour. Later at a practice meeting the


dentist learns the receptionist had been left frightened and in tears by Ms A’s behaviour. It is decided by the practice to write to Ms A informing her that she is no longer welcome at the surgery. A few days later Ms A replies by letter objecting to the practice’s “overreaction” to the incident and further complaining about the inconvenience of the lunchtime closing. The PM contacts MDDUS for advice.


ANALYSIS/OUTCOME: An MDDUS practice adviser discusses the issue with the PM and agrees that it is entirely unacceptable for practice staff to be subjected to verbal and physical threats by a patient – and that removal from the practice list is a reasonable response. The practice is advised to send a second letter informing Ms A that her complaint will be discussed at the next practice


capacity then the disclosure can be made. If not, the doctor should proceed on the basis of the patient’s best interests which would normally involve discussions with a patient’s relatives or carers.


KEY POINTS • Never assume a patient lacks capacity to make a decision based solely on a factor such as a medical condition or mental illness.


•


Patients with diminished capacity may still be able to make simple decisions about their care, even if they are unable to decide on more complex matters.


meeting but that the removal from the list still stands. The letter also advises Ms A that if she further objects to the decision she is free to take up the matter with the ombudsman. Contact details are provided.


KEY POINTS •


Adopt a zero-tolerance policy to physical and/or verbal aggression against practice staff .


• Immediate removal from the practice list is justifi ed if a patient has been violent and/or verbally abusive.


•


Ensure practice opening times are prominently displayed to avoid such complaints.


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