The doctor-patient relationship can lay doctors open to unwanted attention from their patients, whether this takes the form of amorous advances or varying degrees of more aggressive harassment, which can at times reach dramatic and disturbing proportions.
Unwanted contact can range from phone calls, messages or social media contacts, all the way to stalking, verbal and physical abuse, and just occasionally serious acts such as assault. Although harassment of doctors is a fairly rare occurrence, it is nonetheless distressing for those who have to deal with it.
Unwanted attention of the amorous kind - where a patient develops a crush on a GP or a hospital doctor - can start with a patient flirting with the doctor. Initial behaviour might seem quite 'low grade' and easy to brush past, but if attempts are not made to stop it early on, it can lead to the sending of messages and gifts and to stalking and pestering, as the patient creates a fantasy affair of which the doctor may remain entirely unaware.
Seeing their advances ignored or rebuffed, such patients' behaviour can quickly begin to become more aggressive. While such implicitly sexual behaviour may seem totally harmless, if left unchecked - or, worse, apparently encouraged - it can quickly escalate.
It is vital to contact the MDU as soon as you become aware of any potential difficulties with a patient. You should keep a log of all calls and contacts, and retain the originals of all letters and gifts and screenshots of messages. These can be forwarded to the MDU later if necessary, for use as evidence. Contact may be surprisingly frequent: patients have been known to bombard their doctors with hundreds of messages.
Another kind of unwanted attention and harassment may come from patients who for whatever reason bear a grudge against a doctor, perhaps because they feel the doctor has not provided them with the treatment they deserve or has been the cause of the complaint from which they are suffering. At its very worst, such harassment has come not only from the patient themselves but also from the patient's family members and friends.
The government takes violence against healthcare professionals very seriously and the NHS takes a zero-tolerance approach. Your NHS workplace is likely to have a policy in place, so make sure you are familiar with it.
This can include taking precautions as needed. If you believe that you or your staff or family are at risk of physical assault, call the police, but remember your duty of confidentiality to patients and only provide the minimum, necessary information. The MDU's helpline operates 24 hours a day, so you can call at any time - day or night - if you need urgent medico-legal assistance.
If you work in an NHS trust, it would be appropriate to let the medical director and trust legal department know of any difficulties you are having, and it might be necessary to improve security around the unit. If you have good reason to believe that other colleagues on the team could be at risk, you should warn them and follow any trust protocols for such situations.
Patients have been known to appear without an appointment and cause chaos in outpatient departments, compromising patient care. As a GP, you can inform your commissioning body too, which may give practical advice.
If you find that you are receiving unwelcome attention, the very first step is to gently but firmly ask the patient to stop. This is often successful.
Keep your manager (for example, your clinical director or GP partner/s) informed of the situation right from the start. If the patient does not stop the unwanted behaviour, it may be effective for your manager/partner to write formally to the patient.
Engaging in a course of conduct amounting to harassment is a criminal offence under the Protection from Harassment Act 1997. Some types of harassment may amount to discrimination under the Equality Act 2010. Because of this, it may be appropriate to breach patient confidentiality and report the matter to the police, but please do call us for advice on this sort of difficult situation.
It is vital to contact the MDU as soon as you become aware of any potential difficulties with a patient.
The professional relationship
If the doctor-patient relationship has irretrievably broken down, you may find it necessary to end your professional relationship with the patient. The GMC says in 'Good medical practice' (2013) that you should end your professional relationship only when the breakdown of trust means you cannot provide them with good clinical care.
In 'Ending your professional relationship with a patient - ethical guidance summary', the examples of behaviour that may lead to a breakdown include violence, threats, abuse or sexual advances by a patient. If you are considering removing a patient from your GP list, please see our separate guide - Removing patients.
If you decide to continue to care for the patient, you would be advised to have a low threshold for the use of a chaperone, especially for intimate examinations or home visits. Doctors can be at a higher risk of complaints alleging inappropriate conduct from patients who are already suffering with delusions about their relationship with their doctor.
You may, of course, consider that the behaviour is part of a mental health disorder and decide to take appropriate action by referring the patient for a psychiatric opinion. Rarely, you may yourself be part of a patient's complex delusion.
Professionals who appear to be most at risk are GPs, psychiatrists and cosmetic surgeons. Cosmetic surgeons may occasionally find themselves treating patients who suffer with dysmorphophobia, which gives them a distorted view of their body. These patients can rarely, if ever, be treated to their satisfaction by surgery, and can become aggressive when disappointed with their treatment. If you have any concerns about a patient's mental health before surgery, it may be appropriate to seek an opinion from a colleague with an interest in such disorders.
Risk management advice
- Keep strict boundaries with your patients. We have more advice on this in our separate guide on the main website - Maintaining patient boundaries.
- Keep a log of contacts.
- Keep alert.
- Keep cool, but act appropriately if in danger. It is appropriate to seek help from the police if you believe there is a risk of serious harm.
- Keep medical information confidential and disclose only the minimum necessary if you report your patient to the police.
- Keep the MDU informed and call to discuss any difficult situations.
Dr Catherine Wills
Dr Catherine Wills
MA(Oxon) MB BS LLM FRCP MFFLM
Catherine joined the MDU in 2004 and is deputy head of the advisory department. Previously, Catherine was a hospital consultant in general medicine, diabetes and endocrinology.
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