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Patients boycott your smelly partner

Three GPs share their approach to a practice problem

Three GPs share their approach to a practice problem

Case history

A steady stream of patients have made comments to you about the foul odours coming from your partner and in fact some patients will refuse to see that doctor for that very reason. You have noticed it but it does not seem that bad, most of the staff have made no comment and there is no issue about the doctor's performance. What action should you take?

Dr Lucy Free

'It's important to be discreet but dispassionate'

Like it or not, this is a problem that must be addressed; no good will come of it, but you have to say something. It is important to be discreet but dispassionate about this – look at it the other way round. How would you like it if someone told you that you smell? There is no easy way to do it and you simply have to pick your moment.

You need to avoid euphemisms – are we talking halitosis or farting here? Clearly it helps to know your target and to be able to pitch your approach appropriately. Is your partner ill? Shabbiness and malodours could be signs of anything from depression to diabetes and incontinence to impecuniousness, and it's important not to put your foot in it.

But foul smells are intrusive and unpleasant – who enjoys examining smelly people? If people stink then you don't want to go near them, either as doctor or patient, and the interaction of the consultation is lost.

It means nothing that the staff haven't complained – they are in a delicate position and probably didn't feel able to. This has gone further than surreptitiously plugging in a an air-freshener; you have to speak to him.

I think the place to start is with the recognition that there are no issues with the doctor's performance; from there it gets difficult. Clearly the key to this is the personalities of the participants, but there's nobody else to do it, and you have to get on with it.

It would almost be a good thing if there were something wrong with the chap – at least it would give you something concrete to work on, but you open a can of worms if the problem is a social one. Doctors make bad patients and you may need to spell things out simply – perhaps it would be easier to refer him to his own GP.

Take comfort from the fact that this is better addressed sooner rather than later. It doesn't sound like the problem is going to resolve itself, and the proverbial stitch in time may save the day.

Dr Tonia Myers

'Be subtle – first try aftershave and antiperspirant!'

This scenario makes me squirm with discomfort just thinking about it. Patients sometimes avoid a particular GP for other, less smelly, personality reasons and this can be just as difficult to confront as body odour.

Most of us would probably default to the ostrich approach in the hope that it would go away. In the likely event the problem persists, I would try the subtle approach next.

One idea would be to hijack the office Secret Santa at Christmas by making sure his gift is an antiperspirant and aftershave set! Less subtle perhaps would be to throw his window wide open every time I go into his room and complain bitterly about the ventilation and about smelly patients.

I might even break into his consulting room and leave some nice air-freshener on his window ledge when he isn't there. If all else fails, then I would enlist the help of my other partners. If they agree that something must be done, then we should decide which of us should have 'the conversation'.

This should be the person closest to him and who could do it in the most tactful way – which hopefully is anyone else but me! If it fell to me, I would rehearse the chat to myself first. I would open by saying I had something to say that was quite difficult for me and I hoped it wouldn't upset him.

I would then bite the bullet and say that a number of patients had complained about odours coming from his room and were refusing to see him because of this. I would add that I was sure he would want to know about this issue, so that he could do something about it, and so we could then put it behind us and no more needed to be said.

I would then wait for his reaction – he may be mortified or he may just laugh it off. Depending on the outcome, I would then play it by ear and either attempt to comfort him (verbally!) or bid a hasty retreat. Ultimately the only way to bring this smelly problem to a sweet conclusion will be to confront it head on.

Dr Robin Fox

'Help him – but make sure you help the patients too'

When multiple patients refuse to see a partner in the practice, there appears to be a significant issue. While being presented as a problem with body odour, it is important to ensure there are no other hidden agendas, particularly as I have not noticed it to be too bad.

Perhaps I need to start my nasal steroid again if I am the only one not noticing the problem. I would sensitively explore this with suitable patients or any staff who raise this issue.

While most of the staff have not mentioned a problem, this may reflect the fact my partner is their employer. Assuming the problem genuinely appears to be odour, and in view of the complaints to date, then we need as a partnership to take things further. I would speak to whichever of the partners had the best relationship with him and suggest they talk to him.

Things need to be handled sensitively and it needs to be determined why things have changed. If we are lucky then a cat may be rotting under the floorboards of his room. Perhaps I may have discovered my first case of trimethylaminuria (fish-malodor syndrome).

This partner may genuinely not be aware of the problem, but I suspect other possibly personal life events may be occurring. We need to be supportive and see what we can do to help, but at the same time we need to ensure things improve from the patients' perspective.

What does this teach us?

Learning checklist

Why might this be happening?

  • Levels of personal hygiene are very variable but when this is interfering with social function, it can be assumed to be outside the normal range
  • It is important to consider possible physical causes for this such as irritable bowel syndrome, inflammatory bowel disease or mobility issues. Could this be associated with a disability?
  • Consider underlying problems such as depression, alcohol abuse and marital breakdown. Why hasn't someone at home commented on the problem?
  • Are there cultural factors involved?

What do you need to find out?

  • You need to know how long the problem has been going on. Has he always had the problem, or is this a change in his behaviour?
  • How many patients have complained and who has noticed among the staff?
  • How much gossip is already going on both inside and outside the practice?
  • Are there any other concerns about the particular doctor's behaviour?

The partners need to discuss these issues and decide the most suitable person to talk to the GP concerned.

How might you speak to the doctor?

  • Choose the right moment, in private and with enough time to deal with an emotional or angry reaction
  • Use words such as 'I feel there is a problem with...' rather than an assertion such as 'you are...'
  • Listen to the reaction and employ tactics such as 'I can see you're upset...'
  • Try to help him see how it feels for other people and encourage reflection on how it is interfering with his work
  • Any underlying problems may come out but if not if may be best to just deal with this issue for the time being
  • Discourage gossip but do encourage staff and partners who reported the original problem to let you know if further problems are evident

Dealing with sick GP colleagues

  • If there is an underlying problem, the GP involved needs to be encouraged to seek help, probably from his own GP
  • Good Medical Practice advises that GPs should be registered with a doctor, preferably outside their own practiceSick Doctors Trust offers advice and sometimes interventions.

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