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How can I manage a patient who has a crush on me?

Continuing our series on medico legal situations your practice could face, the MDU advises on how a GP might respond to the inappropriate advances of a patient.

Continuing our series on medico legal situations your practice could face, the MDU advises on how a GP might respond to the inappropriate advances of a patient.

The case

A young male patient has developed an unhealthy attachment to me. I first saw him when he registered with the practice. Since then he has called the surgery several times asking my advice about a minor sports injury.

He sent flowers as a thank you, and last week he appeared at the surgery as I was leaving and asked if he could offer me a lift home. How can I make it clear to the patient that his attentions are inappropriate?

The advice

The doctor-patient relationship is central to the trust between a doctor and his patient, and medical professionals have a duty to ensure that the appropriate balance is maintained at all times.

While it is heartening to know that a patient is grateful for your clinical management of their care, there are situations where it becomes apparent that a patient may have inappropriate intentions.

In this scenario you are right to want to nip this problem in the bud as if unchecked the patient may think you are condoning his actions.

This could lead to real problems in the future.

Appropriate boundaries

When you become aware that a patient may have over-stepped the appropriate boundaries, it may be enough to remind him, gently but firmly, that your only role is as his GP.

Ask him to stop sending you flowers and not to contact you outside the surgery. The situation should be discussed within the practice to decide on the most appropriate response.

Sometimes a letter may be sent to the patient by the practice manager asking him not to contact you inappropriately, and suggesting that it would be advisable for him to consult with other partners in the surgery in future.

Remember, though, that in an emergency it may be necessary for you to treat the patient.

If you decide to continue treating the patient, you may want to suggest a chaperone is present during consultations, particularly for intimate examinations or home visits.

Keep a log

Every situation is different and you may wish to consider contacting your medical defence organisation as soon as you become aware of potential difficulties with a patient and keeping a log of all calls, letters and gifts.

In its guidance, Maintaining Boundaries (2006), the GMC advises: "If a patient displays sexualised behaviour, wherever possible treat them politely and considerately and try to re-establish a professional boundary.

If you should find it necessary to end the professional relationship you must follow the guidance in paragraphs 38-40 of Good Medical Practice."

If you believe the doctor-patient relationship has irretrievably broken down, you may have to consider removing the patient from the practice list.

This action should only be necessary in the rarest of circumstances and as a last resort.

Inform the patient and the PCT of your decision and the reasons, in line with paragraphs 20 and 21 of Schedule six of the National Health Service (General Medical Services Contracts) Regulations 2004 or Primary Medical Services requirements.

Make it clear that the patient will not be left without a GP and provide information on how to begin the process of registering with another practice.

In extreme circumstances - for example, if the patient becomes aggressive - a stronger approach may be necessary. Your defence organisation can advise you about this.

Learning points:

• Keep strict boundaries with your patients

• Involve your colleagues in the practice

• Keep a log of contacts

• Keep calm, but act appropriately if in danger

• Keep your medical defence organisation informed.

Dr Yvonne McCombie is a medico-legal adviser with the MDU

Medico-legal advice: How to manage a patient who has a crush on you

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