Dilemma: Lending £10 to patient
A patient attends with an abscess that needs to be seen at the local hospital. It’s not serious enough to need an ambulance, but the patient has no money for a bus or taxi. What should you advise the patient to do?
Suggest an alternative solution, such as using a local volunteer service
We are often viewed (thank you Daily Mail) as being as rich as Croesus and I have been asked in the past for a loan from a patient.
We are obliged to be absolutely beyond question in our financial dealings with a patient as part of our GMC duties. There is no explicit prohibition in the GMC guidance about lending money to a patient – but I have come across some situations in which GPs have got enmeshed in financial dealings that have led to GMC complaints. You can imagine if the patient were a young woman and an older male doctor lent her money – and she then told her friends that he had paid her for services rendered.
Here we have a much simpler situation where a patient needs an NHS service and has difficulty in gaining access to that service. Calling a blue-light ambulance in this situation would be farcical, so alternatives must be explored. These include local volunteer drivers – the old ambulance car service or its equivalent – or public transport or a commissioned patient transport service.
This is clearly a non-emergency/urgent transport requirement and I would call on the local patient transport service, recently commissioned in my area from Arriva. It may be that transport would have to wait until the next day but this could be clinically appropriate.
But lend him a tenner? Not on your nelly.
Dr Peter Swinyard is chair of the Family Doctor Association and a GP in Swindon
Use an ambulance if you have no alternatives
For me, lending money to a patient crosses a line and so this dilemma would prompt me to re-evaluate the patient’s clinical condition. If I saw no alternative to emergency hospital treatment, I would try to arrange ambulance transfer. Otherwise, I might consider aspirating the abscess myself and prescribing oral antibiotics, or, depending upon skills and facilities, lancing it in the surgery.
Lending him the money would come close to infringing the GMC’s ‘Duties of a Doctor’, which warns against accepting or offering gifts which might be seen to affect the way I treat patients. Imagine how I might feel towards him subsequently if he did not pay me back or did not use it on a taxi to hospital.
This man and his community need to find resilient transport solutions. I’d be happy to help them find solutions – perhaps help to set up a charitable hardship fund – but not to provide them.
Working out of hours, I am struck that those patients who argue most passionately for a house call citing lack of transport often reach the centre the quickest! Who knows, just as lending him the cash requires a closer relationship than I might be happy with, succeeding in finding a lift might even help to strengthen ties between him and his obliging neighbour.
GPs have the skills and limited resources to provide medical treatment. We should resist the temptation to try to, or be seen to, provide non-medical interventions. We are poorly placed to judge the financial merits of each case.
Dr John Cosgrove is a GP in Birmingham and a founder member of Grassroots GP campaign group.
Start a slush fund for these patients
I have had situations like this arise in my practice. As a result we have a clear practice policy, and have taken steps to avoid such situations whenever possible. Our policy is that we advise none of our staff to lend money to patients – no matter how plausible their lack of funds, or needy their case. Past experience has shown that it usually results in the lender being permanently out-of-pocket.
In an attempt to avoid such situations, a neighbouring practice had set up a cash reserve fund. This practice has charitable fundraisers and keeps small donations from grateful patients. This money serves as ‘petty cash’, and can be used to ‘lend’ money for taxis in cases such as this.
In my practice, with our policy in place, our patients usually find a friend or relative they can ask to give them a lift, or lend them funds.
Recently, however, when faced with a long wait for an ambulance, a member of my staff did kindly drop a patient at the hospital on their way home.
Thus my answer would be: ‘No, I cannot lend you money’. I do not feel that refusing such a request would impact on the doctor-patient relationship- so long as it is made clear that it is practice policy is being followed, and nothing personal.
It should be made clear that as GPs we do not hold sole responsibility for people’s health needs. Patients must be able to take responsibility for their own health too by making sensible choices (by ensuring they have adequate funds for emergencies or friends who can help at times of need).
If GPs aren’t careful, acts of kindness become expected tasks, and other requests will follow – do you really want to take home the homeless man on your doorstep once the hostels are full?
It is important to seek and provide the best possible care for our patients, but we must not blur our responsibilities, as in so doing we may ‘dilute’
our professional integrity.Dr Vicky Blackburn is a GP in Stonehouse, Gloucestershire.