Sessional GP and MPS medicolegal consultant Dr Rachel Birch shares a case scenario about a patient who stalked her GP

Dr L worked as a locum GP in Manchester, doing maternity and other long-term locum jobs within the city practices. Five years ago he saw a female patient, Miss X, with mental health symptoms. He spent time trying to help her to resolve some of her issues. She was referred to counselling and to psychiatry and was found to have a borderline personality disorder.

Dr L’s six-month locum post ended and he moved to a neighbouring practice. Two weeks into his job he was asked to see a new patient… Miss X. She told him she felt he understood her and wanted to remain his patient. He saw her as a patient for the next four months, but then he moved to another practice in the area. Again Miss X registered at the new practice.

Over the following months Miss X managed to obtain Dr L’s mobile number and his work email address. She started to send daily texts and then emails. The nature of her correspondence gradually changed and in one text she commented on the fact that she was disappointed that he was married.

Although Dr L asked her several times to stop texting and emailing him, she continued to do so. The content of her messages implied that she was “collecting” information about him. She started to comment on his wife’s appearance, and admitted that she was visiting his wife in the local jewellery shop where she worked. She told Dr L to get his front lawn landscaped and made reference to the colour of his bedroom curtains.

Dr L asked Miss X in for a review appointment and asked her to stop contacting him and to see one of the other doctors in the practice. She became upset but agreed to do so. He no longer saw her as a patient, but found that whenever he was in town she would seem to “bump into him”.

He realised how serious things had become when his wife received a letter from Miss X stating that she was in love with Dr L and would not stop following him until her feelings were reciprocated.

How to avoid this scenario

Whilst it is right to offer patients advice and support, there may be circumstances where a patient starts to rely excessively on contact with you. It may be very flattering if a patient tells you that you are “the only doctor that understands”, but

 remember there may be a hidden danger within these words.

• Recognise the signs early that a patient may be starting to become over-reliant on you. In Dr L’s case Miss X moved practices to continue a professional relationship with him.
• If you feel that a patient is consulting too regularly, consider asking him/her to attend another GP within the practice for a second opinion. There are times when an objective viewpoint can help, especially if the patient has unresolved symptoms.
• There are occasions where a patient may obtain your mobile number – for example, if you have called them to ask for directions for a home visit. If you start to receive calls or texts on your mobile phone, politely and firmly ask the patient not to contact you in this way and ask them to contact the practice if they wish to make an appointment with you.1
• There are risks associated with patients emailing doctors, especially if doctors are part-time and are not able to access their emails regularly.2 There is also the danger that a patient sends an email out of hours and it is not seen until the next working day. Advise patients not to contact you by email for the above reasons. Ensure that you inform the practice manager about the emails you have received. Emails and texts from patients should be filed in their medical records.
• Remember to maintain professional boundaries with patients. The GMC advises that “if a patient pursues an improper emotional relationship with you, you should treat them politely and considerately and try to re-establish a professional boundary”.3 In Dr L’s case the comment about him being married should have alerted him to the fact that the professional boundary was becoming compromised.
• Consider whether the patient may have a mental health disorder and discuss this with colleagues and offer a psychiatric opinion if indicated.
• If the patient’s behaviour doesn’t stop, you may feel that there is a breakdown of trust between you and the patient. You should discuss the matter with your GP colleagues. Ensure that you follow GMC guidance.4 Discuss your decision and your reasons with the patient and ensure that he/she has access to appropriate follow up, perhaps in the first instance with one of the GP principals.
• Document all the steps you have taken carefully and keep a record of these. Keep a log of all the emails, texts and letters you have received in case of a future complaint against you by the patient.
• Consider discussing your concerns with your medical defence organisation and follow their advice.

If the above measures don’t work…

Remember that although you are a doctor, you and your family are entitled to the same privacy and protection as other people. It can be extremely distressing to be subject to unwanted attention and stalking behaviour from current or former patients.

• Continue to document any unexpected contact you have with the patient. This may be required as evidence if you have to take further action.
• Remember you have a duty of confidentiality to patients, so do not discuss clinical details with your own family or friends.
• In such circumstances, you should only disclose the minimum, relevant information and you should take care to avoid disclosing clinical information.

Remember that although you are a doctor, you and your family are entitled to the same privacy and protection as other people

As this case illustrates, although such a scenario is more likely to be encountered by GP principals, locums are not immune to unwanted attention. If you have any concerns in this area, contact your medical defence organisation for advice.

References

1. MPS, Communicating with patients by text message (2013)
2. MPS, Communicating with patients by fax and email (2012)
3. GMC, Maintaining boundaries: maintaining a professional boundary between you and your patient (2013)
4. GMC, Ending your professional relationship with a patient (2013).