Unreasonable behaviour - medical case study

27 July 2011

BACKGROUND: An 81-year-old man, Mr G, is deaf and has a history of heart disease and diabetes. His son Mr CG holds power of attorney for his father. When Mr G becomes unwell, suffering stomach pains and nausea, his GP Dr N agrees to make a home visit. An examination of his abdomen reveals no abnormality so Dr N prescribes medication to alleviate the symptoms and arranges for a follow-up examination at the practice.

A few days later Mr CG comes into the practice to speak to Dr N and they disagree about Mr G’s condition and the recommended treatment plan. Mr CG becomes angry and raises his voice, insulting Dr N and threatening to make a complaint about her to the GMC. Dr N contacts Mr CG to speak to him about his behaviour but he is again verbally abusive. Dr N reports this to the practice’s senior partner who decides to take steps to remove Mr G from the practice list due to his son’s unacceptable behaviour.

The practice tells the PCT about the decision and Mr G is also informed in a letter from the senior partner that explains the decision and includes information on registering with an alternative practice. One week later, Dr N receives notice from the GMC of a complaint made against her by Mr CG alleging Mr G was removed from the list without a valid reason.

ANALYSIS/OUTCOME: Dr N contacts MDDUS and a medico-legal adviser helps her draft a response to the GMC. She is advised to highlight the fact that Mr CG’s complaint had already been appropriately handled by the senior partner. She is also advised to explain that the practice’s decision to remove Mr G was in accordance with their policy regarding abusive and aggressive behaviour from a patient or carer.

The adviser recommends the practice provides evidence of their compliance with the GMC’s Good Medical Practice guidance by including a copy of the senior partner’s letters to Mr G and the PCT. On the basis of this response, the GMC concludes that the practice was justified in removing Mr G and recommends the case is closed.

KEY POINTS

• Removal from a practice list is justified only in cases where the doctor/patient relationship has broken down – for example, if the patient has acted unreasonably or been violent to you or a colleague.
• Be prepared to justify a decision to remove a patient and inform the patient, in writing where practical. Removal without first informing the patient in writing should only be done where there is real, or a threat of, violence to doctors/staff.
• Always follow GMC guidance detailed in Good Medical Practice paragraphs 38-40. Refer to RCGP’s 2004 guidance Removal of Patients from GPs Lists.