By Kate Cowan, Case Manager, Medical Protection
A female patient, Miss Y, who had a past history of mental health issues, had asked GP Dr C to become friends outside their normal doctor–patient relationship. She had also informed Dr C that she had followed him on Facebook, and she also gave him copies of her diary, which had inappropriate comments regarding her feelings towards Dr C.
Dr C explained to Miss Y that their relationship could only be that of a doctor–patient relationship and if she felt she couldn’t consult with them in this capacity only, it may be more appropriate for her to see a different GP at the surgery. Miss Y was very upset by this and, as she had previously had thoughts of suicide, Dr C arranged to see her again and requested advice from Medical Protection on how to proceed if this behaviour continued.
How Medical Protection assisted
A Medical Protection case manager handled Dr C’s query and began by running through the official local guidance on maintaining professional boundaries between doctors and patients. As Miss Y had a past history of mental health issues, the case manager asked if she was currently under the care of the mental health team. She also explained that if Miss Y continued with the behaviour, a professional boundary should be established and, if needs would be better met by referral to a GP colleague or the community mental health team, then this should be arranged.
The copy of Miss Y’s diary should only be documented in the medical records if Dr C felt it was an example of the patient’s mental health illness, as this would be a justifiable reason to record the details. The case manager suggested that Dr C could also request consent to share the document with the mental health team – if they were involved – as this could be an insight into Miss Y’s current thoughts and feelings. If Dr C did not think it was justifiable to keep the diary entries in the notes, then he needed to ask Miss Y whether she wanted the document back or if it could be destroyed.
Dr C was also advised to update his security settings on his Facebook account and to get back in touch if the matter escalated. Some time later, Dr C did get back in touch with Medical Protection to say that Miss Y had sent him a Valentine’s card. He was by now very keen to end the doctor–patient relationship and had drafted a letter to Miss Y to explain this, adding that a different GP at the practice would now be taking over her care – although if he was the only GP at the practice and it was an emergency situation, he would still see Miss Y. The Medical Protection case manager reviewed the letter for tone and content before it was sent to Miss Y.
Unfortunately, Miss Y then sent a complaint to the regulator and numerous letters to the practice. The practice and Dr C were feeling harassed by Miss Y and this was starting to cause anxiety. We assisted Dr C in preparing a response to the complaint, which was sent to the regulator, and we then asked Dr C to send us all the further documents sent by Miss Y so we could advise on next steps.
The regulator suggested a meeting between their complaints officer, the practice manager and all GPs at the practice to discuss the matter further, which Dr C agreed to attend. We advised Dr C to attend so he could explain the impact the issue was having on him and the practice. He took with him the documents previously received by Miss Y to illustrate the issue.
Outcome
Miss Y was removed from the practice list. Dr C received one more card from her but then nothing further.
Learning points and discussion
- Dr C did have good security on his social media accounts, but this case is a reminder that social media accounts should be kept private.
- If a patient develops an emotional attachment, explore the reasons behind this and discuss with the patient professional doctor–patient relationship boundaries. In this case, Dr C had done this impeccably but sometimes a patient can carry on with an emotional attachment and then further steps need to be taken.
- It is important to share concerns about patients crossing boundaries with colleagues rather than keeping this information to yourself. Should things turn sour, it can be helpful to have the history of the issues documented with colleagues.