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Practice dilemma: Dealing with a demanding patient

A demanding patient has obtained one of the GP's personal email address and started to make requests and complaints directly to the GP. How should you deal with this?

Dr Helen Hartley, medico-legal adviser at Medical Protection says:

You should first consider how the patient obtained the GP's personal email address and ensure that it is not publically signposted as a route for patients to correspond with you. Even though you may be keen to resolve the patient’s concerns quickly the GP should avoid using their personal email account, as it is an insecure means of sharing confidential patient information and an unsatisfactory way of resolving disputes.

Allowing the patient to bypass proper communication channels would tacitly approve them continuing to use the email address, potentially jeopardising their future care if the GP does not happen to see or read later emails containing significant health information, and threatening the GP's professional boundary.

A polite request to the patient to use the practice email or complaints channel and an explanation that this will ensure their enquiry is dealt with by the appropriate person, quickly and securely, should help to resolve the matter.

If a patient contacts a GP directly via a professional email, it is up to the GP as to whether they want to correspond in this manner or direct them to the practice email address. It may seem helpful to correspond directly, but GPs must be aware of the risks, particularly in raising patients’ expectations of response times, the additional workload dealing with requests, and ensuring emails are not missed in your absence. The practice should also ensure there are appropriate levels of encryption to avoid confidentiality breaches and that all correspondence is recorded in the patient’s medical records.

Dealing with any complaints

The Health and Social Care Act 2012 requires GP practices to provide accessible information to patients regarding making complaints. If the patient has submitted a formal complaint directly to you, it may suggest that the correct pathway is not clear so you should check that your practice is meeting that obligation.

Under the NHS Complaints Regulations, all complaints, other than those brought orally and resolved by the end of the next working day, should be acknowledged orally or in writing within two (Wales) or three (rest of UK) working days.

The GP should forward the email to the practice complaints manager who should contact the complainant to discuss the likely timescale of investigation, and seek their preference for a written or email response or a meeting to discuss the findings. This would be a good opportunity for them to reiterate the complaints policy, including contact details, and the patient should be given a copy of, or signposted to, the practice complaints policy.

Dealing with continued contact

If the complainant continues to send emails to the GP's personal email address the GP should respond from his or her professional email address stating receipt of email and providing the correct contact details, indicating that they do not use their personal address for practice business.

The GP may wish to create a rule automatically forwarding emails to the practice and make the patient aware that this is the action taken. The GP should inform the practice so they can promote the proper communication channels for complaints or requests.

The patient should not suffer a detriment through trying to contact a GP directly; they may be distressed or disappointed at the treatment received at the practice, or they may simply misunderstand the appropriate processes.

However, persistent or unpleasant correspondence to any email address causing the GP to feel harassed and damaging the doctor/patient relationship irretrievably, may trigger the practice to consider patient de-registration.

Before doing so you should seek medicolegal advice to ensure you follow the appropriate process, because if the matter was escalated for independent review, it could attract Ombudsman criticism.

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Picture: iStock

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