Dilemma: Harassing calls from the parent of a patient
As a practice you care for a number of students away from home. A particular parent phones regularly to talk about their child who is 18 and a first year.
As the weeks pass they become increasingly frustrated with the gentle reminders that you cannot discuss the young adult without consent, and consent has not been given. The parent becomes aggressive on the phone and some admin team members no longer feel comfortable speaking to them. How would you manage this?
Tragedies seem to occur when nobody knows about a particular student, and the student is unaware of the help available
Sending a child to university often comes as a shock to parents. Every autumn term we have a number of phone calls and sometimes even visits from concerned parents about their sons or daughters.
Many of the students who gain a place at university have done so despite much physical, emotional and psychological problems, and a place at university has been the pinnacle of achievement for both the parent and the student. Sometimes this achievement comes with little thought about what happens next. You don’t just suddenly stop being the parent. Psychological problems form the biggest part of our work at the university and going to university is a major life event. It’s not surprising that the parent and the student sometimes find this destabilising.
In our scenario, this parent needs to talk to the doctor. The doctor does not have to give any information about the patient but should listen to the parent’s concerns. The more information we have the better care we are able to offer. The university has support mechanisms far in advance of that available to others the same age. Student counsellors, facilitators, personal tutors, finance advisors are all available. The biggest tragedies seem to occur when nobody knows about a particular student and the student is unaware of the help that is available.
When the parent has voiced their concerns and given us permission to pass them on, we can then contact the student on their mobile phone and ask them to come and see us at the surgery. We can encourage the student to give us permission to talk to their parents but inform them that they don’t have to give us permission. We can tell them that what they tell us is confidential unless they want their parents to know.
Dr Phil Rowland is a GP at Peverell Park Surgery and University Medical Centre, Plymouth.
I would advise the student to register with a university GP for the duration of the course
My duty of care is to both patients, the parent and the student. I want to sustain my good relationship with the family, but protect the practice team from exposure to abuse.
I would contact the student direct to ascertain if they are having any issues that I can help with – not simply medical issues, but finance, emotional difficulties, or settling into university life. This would enable me to explore their relationship with their parent. Both patients’ confidentiality must be maintained, but talking will give me an insight: has it been easy leaving home, are you enjoying the move, making new friends, and developing a life for yourself?
Then I would strongly advise the student to register with a university GP for the duration of the course. If the student is reluctant, I would point out that they are cutting themselves off from the complete service tailored to student needs that the university GP can offer.
This would then help me deal with the parent. I can address the aggressive behaviour directly, and what may be issues like separation anxiety, empty nest syndrome and possible depression.
Lastly, I would ask reception to refer any further difficult calls from the parent to me. I would not break confidentiality with the student to the parent without the student’s written permission: that permission should really already be in place. Explaining to the parent that the student was no longer a patient (until such time as the student returns home, of course) would stop the difficult calls to the practice.
Dr Sara Shackleton is a GP in Standish, Wigan, and a council member of the Family Doctor Association.
Doctors should establish what information patients want you to share, who with and in what circumstances
As a busy GP, dealing with demanding relatives is a common dilemma. It can be a difficult balance, maintaining enough of a relationship with them to ensure you have taken their concerns on board, while not compromising the confidence of the patient themselves.
In this scenario, the parent in question has presented the practice with challenging behaviour leading to a breakdown in the relationship with some of the practice staff. Why is this parent so worried? Is this a case of an over-anxious protective parent who has had difficulty letting go of their child leaving home, or is it a sign of something more serious? Is there something going on with the student which you should be alert to?
Perhaps contacting the student and trying to find out more would be helpful. If there something going on with them, then you can ask for permission to discuss matters with the parent in question. If not, then it may be a case of managing the parent’s anxieties as diplomatically as possible, with minimal upset to the practice staff.
The GMC’s confidentiality guidance states that doctors should establish what information patients want you to share, who with and in what circumstances. The guidance also states that you may listen to the concerns of those close to the patient, but that you should inform them that you cannot guarantee you will not tell the patient about the conversation, particularly if it may influence their future treatment.
The practice staff’s unhappiness with the parent’s behaviour is concerning. If you establish that there is an underlying problem contributing to the anxiety and aggression, it would be appropriate to explain this to the practice staff, along with a polite but firm reminder to the parent that their behaviour, although somewhat understandable, is not acceptable.
It may also be helpful to have one or two members of the administrative team, who are comfortable taking the calls of this parent as the sole point of contact at the practice. If the difficult behaviour continues regardless of your cautioning, I would suggest taking advice on the way forward from your medical defence organisation.
Zaid Al-Najjar is a medicolegal advisor at the Medical Protection Society