A patient has sent me a Valentine’s Day card together with a valuable gift. How should I respond to this?
Dr Matt Piccaver: Employ a zero-tolerance approach
We have very clear guidance on receipt of gifts, courtesy of the GMC. We can receive gifts providing they don’t affect the doctor-patient relationship. Guidance once again is very clear on relationships with patients. ‘No sex please I’m your doctor’ is the order of the day. We have clear boundaries as professionals over which we shall not cross. I would argue that the same should be said of our patients.
I have been asked if I would like to go for a beer by patients, but I have had to politely decline. I point out that I might be friendly, but I can’t be your friend. Aside from the occasional inappropriate comment from nonagenarians (much to my staff’s amusement) I’ve never been on the receiving end of amorous approaches from patients.
Personally, I would have a zero-tolerance approach to this sort of behaviour. Politely decline and advise the patient of your duties as a doctor. If this doesn’t change anything, I would ask them to see another doctor. Again, the GMC has robust guidance on how to go about ending your therapeutic relationship with a patient. The prospect of a patient somehow enjoying coming to the doctors for anything other than medical reasons makes me uncomfortable, and my career is worth too much to me to allow such behaviour to continue unchecked. It might sound hawkish, but from me, it’s ‘one strike and you’re out’.
Dr Matt Piccaver is a GP in Glemsford, Suffolk
Dr Sarah Jarvis: Politely refuse
It can be flattering when a patient wants to show you their appreciation but bear in mind that accepting a gift, particularly if the patient has romantic intentions, has the potential to be misconstrued by the patient or others.
The GMC says you must not encourage patients to give gifts that will benefit you directly or indirectly, but you can accept unsolicited gifts if it does not affect your behaviour. If you suspect the patient has romantic feelings for you it might be better to politely refuse the present.
You may decide to write to the patient explaining that you are unable to accept the gift because this would overstep the boundaries of the doctor/patient relationship, which is a professional one. This should hopefully resolve any misunderstandings at an early stage. You may wish to consider whether the patient’s care should be transferred to another GP at the practice, although you must provide emergency care if there is no one else available to see the patient.
If the patient continues to contact you such as through social media sites such as Facebook, or via unsolicited written letters or cards, keep a log of all contacts and get advice from your medical defence organisation on how to manage the issue.
Dr Sarah Jarvis is a medicolegal adviser at the Medical Defence Union
Dr Susie Bayley: Handle it sensitively, yet professionally
The situation is a very delicate one. Whilst considering the implications and pitfalls for the GP, it is important to think of the emotional state of the patient. It should be handled sensitively yet professionally.
For the Valentine’s card, the GMC has advice on maintaining professional boundaries. The hope is that if we practice in this manner romantic attachments will not be formed, but patients don’t necessarily follow GMC guidance. On receipt of the card you should not ignore potential embarrassment, which may act to encourage the patient, but address the matter. You need to be polite but unequivocal. Explain why the card is kind but inappropriate and the importance of maintaining boundaries for both of your sakes. Document the conversation clearly and ask them to stop any further romantic attention. If their affections obviously continue following this, I would discuss the case with a colleague and request they take over the patient’s care. Then, make an appointment for the patient with you and your colleague to discuss the transfer of care, and the reason for the end of the doctor-patient relationship.
For a high value gift, a robust practice policy can protect both doctor and patient, offering a defence for a GP refusing a gift without causing offence. The GMC has clear guidance, which should form the basis of this policy, which should include the contractual requirement that all gifts worth more than £100 should be logged. In practical terms, where there are grey areas and larger value gifts, it would be appropriate, and encouraged, to discuss matters with colleagues. In this case, accepting the gift would undoubtedly affect the way you treat the patient in future.
Dr Susie Bayley is GP in Derby and vice chair of GP survival