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When should you sort a problem out for yourself?

Dr Tim Gietzen feels there are occasions when GPs should be able to sort things out for themselves without troubling their defence bodies

I am often a little exasperated with colleagues who say 'Can't be too careful, can you?' and call in their defence bodies. Surely there are times when GPs can, and should, sort things out for themselves by talking things over with colleagues and using a little common-sense.

The point is well illustrated by an episode which is happening to me at the moment. I find myself being stalked by an 84-year-old patient in a nursing home.

I don't visit her often and when I do it's usually for bronchitis. About six months ago I was a bit surprised, and not a little amused, to receive a letter saying she'd dreamt about me in the night and had woken up crying because I wasn't there. I say amused because I never was an Adonis, and I'm certainly far from one now. Four children does have an effect on one's figure.

I stuffed the letter in my appraisal folder, mentioned it to my wife and left it at that.

The second letter was a week later. The old lady said the staff at the home were being awful to her and it was 'only the thought that I might pop in' kept her going. I took this a little more seriously and we discussed my response at our next practice meeting. In the end I wrote a kindly but formal letter suggesting it was unlikely I'd 'pop in' and that I'd found the last letter a little disturbing.

The practice meeting's only other suggestion was I should keep careful notes of any contact with the woman. I was doing this anyway. My partners also suggested I insist on a chaperone if I visited. One of the partners offered to take over her care, but to me this seemed an over-reaction.

The next letter from this old lady echoed the second, but she added that she forgave me for my letter and 'knew I had to say what I did'. Again I could 'pop in' any time, though she thought the evening would be best as there were 'less staff'. Again she'd dreamed of me, though this time in more graphic detail.

Thoroughly alarmed I telephoned the matron of the home. She said she wasn't particularly surprised. She said the patient was manipulative and unpleasant and regularly reduced junior staff to tears.

We decided the best course of action would be to confront her. She was indignant that I'd chosen to discuss 'our affairs' with anybody else, let alone a member of the nursing staff, who, she was convinced, were all conspiring against her. Despite this, I really couldn't convince myself of any underlying pathology.

The next letter contained £5 to 'buy the children some sweets'. I returned the money with a curt note and a silent prayer of thanks that the practice manager opened the mail and logged any monies received.

Three days later the matron phoned. My patient was in a terrible state, swearing at the staff and demanding to see me. I refused, and arranged a visit by the local psychogeriatric team. Their conclusion was that there was no evidence of psychiatric illness but that she was highly manipulative.

I await the next letter with some trepidation, convinced that Hell will have no fury like this woman scorned. Even so I can hardly throw her off my list. I certainly don't fancy telling the PCO that I'm being stalked by a bed-bound octogenarian. For the same reason I don't really want to pass her care on to one of my partners: after 20 years in the game I feel I ought to be able to cope.

Should I consult my defence body? I don't really see why. I can't see that their advice would be that different to what I've already done. I don't want to become like some of my patients – so in need of reassurance that they can't make any decisions for themselves.

Tim Gietzen is a GP in Eastbourne, Sussex

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