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When enough is enough

Dr Clare Dyer's article was a runner-up in our clinical writing competition.

I have finally given in. I can no longer be that sounding board – the compassionate GP who will sit for 20 minutes (yes, a double appointment) and listen to the sob story of her life and how none of it is really her fault. Today, for the first time in 10 years of general practice, I have requested a patient is removed from my list.

What, you may ask, has driven me to this decision? For it is not something that is done very often in leafy Hertfordshire, and is a decision that I have agonised over for the last week.

A crime, for that is what she committed, will go unpunished bar me refusing to have any more to do with her. The patient has driven me to such anger with her and the system that I have declared a complete breakdown in the doctor-patient relationship.  Last week my patient, who I have been nurturing through prescription medicine addiction, broke the final taboo and forged my signature.

I have been looking after her for the last nine months, the longest she has ever been a patient with a GP, starting with weekly appointments and gradually decreasing the frequency to monthly.

All prescriptions, however, have always been for a week at a time, with the rest post-dated for the following weeks. As with all addicts, I never really believed exactly what she told me, but I felt that we had developed a hint of honesty.

I made promises to her about not cutting her meds without her agreement and she
was to be honest with me about all the medication that she took – both prescribed and over the counter, via the internet and the street.

It amazed me that the local drug and alcohol team believed everything she told them, including that she was taking at least 50% more than what I was prescribing. They made a plan with her on that basis.

Having said that I would never increase her prescription, I was then left with a dilemma – since the drug and alcohol team had put in writing how much they wanted her to have.

The final straw

Then – the week after they had discharged her back to my care and prior to me increasing her meds – she decided she couldn't hold out for two days until her next prescription. Firstly she tried to get her post-dated script dispensed early – something I now believe she has succeeded in doing at least once before – but after failing with this, rather than coming to see me she decided to alter the date on the scripts and forge my signature.

Luckily for her she bottled it, and came to the surgery, admitted her crime and handed us the prescriptions rather than handing them into a pharmacist who I believe would have called the police. It is what happened next, though, that really angered me.

The NHS Counter Fraud Service is not interested because the health service has not lost any money. And my medical defence body says it is not a significant enough crime to warrant me breaking patient confidentiality by going to the police. 

So the only punishment she will get is to have to go through finding another GP. To top it all she has put in a complaint to the PCT about her removal, arguing that it was unfair, and her mother has called me unprofessional down the phone.

So enough really is enough. When the system lets you as a GP down and you feel you have no support from the authorities to deal with criminal activity, all that is left is the rather pathetic response of telling a patient you won't see them any more.

Dr Clare Dyer is a GP in Watford