Case study: Frequent attender

BACKGROUND

Practice manager Mrs T phones MDDUS regarding a patient who joined the practice two months ago. Mr J had relocated across town and said he wanted a practice more convenient to his new flat. Since his registration, he has made almost daily contact with the practice in regard to a variety of medical and social care issues – and is often rude and demanding.

Patient records reveal that Mr J was removed from his previous practice list for abusive behaviour towards staff. The records also show that he has previously had multiple referrals and often did not agree with the outcomes.

A senior partner in the practice has twice had discussions with Mr J about the appropriateness of his frequent use of the service and the effect on demand and capacity. Both occasions resulted in verbal complaints about the practice “denying my rights as a patient”.

Mrs T seeks advice from MDDUS on how to deal with Mr J, as the practice believes removing him from the list will just pass the problem to another practice.

ANALYSIS/OUTCOME

An MDDUS adviser discusses the issue with Mrs T and reminds her of the duty of care owed to Mr J despite his difficult attitude and behaviour. He is still a patient in need, with both physical and psychological issues. It is suggested that the practice consider triaging his telephone contacts to ensure they are dealt with appropriately.

Consideration could also be given to setting up a behaviour contract with Mr J, where both parties agree a code of conduct. It may also be helpful, to ensure continuity and consistency, that one or two of the GPs take on responsibility for dealing with Mr J’s demands.

This should be done with patient safety foremost and without being dismissive of potentially urgent symptoms.

Mrs T is urged to phone MDDUS for further advice on the matter as necessary.

KEY POINTS

• Removing patients from the practice list is the last step in a process.
• Challenging behaviour in patients can be related to specific physical or mental problems.
• Seek ways to reasonably accommodate such patients, but to temper expectations.