Dilemma: Vulnerable patient reveals relationship with receptionist
A vulnerable 18-year-old patient with mental health issues discloses that he has started a relationship with one of the receptionists. How do you respond?
Dr Richard Stokell: Check the receptionist knows the potential risks
The case has the potential to harm the patient and is also likely to create difficulties for the receptionist by affecting interpersonal relationships and risking patient confidentiality.
Find out what is happening and how long it has been going on. What is the patient’s situation – does he have other professionals involved in his care?
My next step would be to discuss the case with the practice manager and safeguarding lead. Review staff contracts, practice protocols and details of in-house safeguarding training. Although staff are allowed to have relationships with patients, the issues of confidentiality and adult safeguarding need to be discussed.
The receptionist also needs to understand how a relationship with a vulnerable patient might be regarded by staff and patients and the practice’s responsibility to report any suspicions to Adult Social Services.
Future confidentiality could be protected by ensuring the receptionist has no involvement in bookings and management of the patient and agrees never to access his records.
Dr Richard Stokell is a GP in Birkenhead and associate director of the Mersey Deanery
Dr Fiona Cornish
: Tell the patient to register elsewhere
Some people’s response to this scenario might well be that it is a private matter between the receptionist and the patient, but GP partners must recognise that it will have an effect on the practice team and so needs to be addressed.
You or your practice manager need to speak to the receptionist to find out their perspective. First and foremost, the receptionist needs to confirm that there really is a relationship between the two parties, and that the patient has not misinterpreted professional kindness as something stronger.
We have had a situation like this at our surgery where a patient thought that one of our receptionists was romantically interested in him and mentioned that she was going to have a drink with him.
This turned out to be all in his imagination, and the receptionist had no intention of going out with him.
If, however, the receptionist acknowledges that the relationship is genuine, the practice manager needs to invite the patient in for a chat. It will be impossible to offer the patient the best care when his confidentiality is compromised by his relationship. It would also become tough for the receptionist to maintain a professional relationship with the patient. The patient should be asked to register at a different practice and the practice manager should explain why this is necessary.
The receptionist’s position would not be adversely affected if she was willing to engage in discussion with the practice manager about the fact that the patient would have to register at another practice, and why.
In summary, it should be possible for this situation to be resolved simply.
Dr Fiona Cornish is a GP in Cambridge and president of the Medical Women’s Federation
Dr Marika Davies:
Review your procedures
We presume that most adults have the capacity to make informed choices about how they live their lives.
But if you have reason to doubt the patient’s ability to make decisions for himself, or if you have concerns that his relationship with the receptionist is exploitative, you should intervene.
The fact that the relationship is with a receptionist may seem a little uncomfortable. Receptionists are not bound by the same professional codes of conduct as healthcare professionals, but you should be confident that all members of practice staff will act professionally in the workplace. Any potential issues of concern should be discussed with the patient and the receptionist and documented in the medical records. That way, if a complaint arises in the future, you can show that you were aware and dealt with it from the start.
It may be sensible to review your practice policy on staff and their families being registered with you, as ‘family’ can include those with whom staff have close personal relationships. In general, it is considered best practice for staff and their families to be registered at a different surgery from the one in which they work. This allows them to receive independent and objective medical care, and avoids the risk of their confidentiality being breached.
Keep the situation under review and contact your defence organisation if you have any concerns.