Dr Ellie Mein
The MDU receives around 400 calls a year to the advisory helpline from members asking how to manage difficult patients. The vast majority came from general practice.
Removing a challenging patient from the practice list isn't always warranted or viable. An alternative strategy is the use of behaviour contracts between the practice and the patient.
Sometimes called doctor-patient contracts or acceptable behaviour contracts, their objectives are broadly the same:
NHS Protect, in its 2012 publication Unacceptable Behaviour - guidance on warning letters and other written communications, outlines strategies for addressing this type of behaviour. The guidance describes the types of behaviour that may be regarded as unacceptable and various ways in which these can be addressed, including Acceptable Behaviour Agreements (ABAs).
Photo credit: Getty
The contract should be viewed as a useful tool in rescuing a deteriorating professional relationship before it becomes unsalvageable, rather than as a punitive measure. The MDU advises using ABAs only in cases of persistent bad behaviour that would inevitably lead to a breakdown in the doctor-patient relationship and removal from the practice list.
Behaviour contracts are more likely to be successful if the patient is involved in drafting it, as a sense of ownership of the contract may translate to a sense of responsibility in implementing it.
Patients may be more receptive to the contract if it does not focus solely on what is expected of them but also explains what they can expect of the service provider in return.
Similarly, the use of positive language can also increase the likelihood of an ABA being successful. By stating what the patient should do - for example, 'treat staff with respect' - rather than what they should not - for example, 'not swear, shout or insult staff' - the patient may be more amenable to the request. There will, however, be cases where it is necessary to be explicit about what behaviour will not be tolerated so the patient is clear about what is required of them.
The MDU highlights other factors that should be considered when using behaviour contracts:
The contract should be viewed as a useful tool in rescuing a deteriorating professional relationship before it becomes unsalvageable, rather than as a punitive measure
This article was correct at publication on 27/03/2015. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
MB ChB MRCOphth GDL LLM
Ellie joined the MDU as a medico-legal adviser in 2013. Prior to this she worked as an ophthalmologist before completing her Graduate Diploma in Law in Birmingham.
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