To treat or not to treat?

20^th February 2023

Receiving a strongly-worded complaint, coming across a harsh online review, or being pursued by ‘no-win no-fee’ lawyers can put a strain on even the healthiest doctor-patient relationships. Many healthcare professionals are understandably reluctant to continue treating a patient who has instructed solicitors to investigate a claim against them, or who has complained to the regulator about their care. But is it appropriate to simply refuse to continue treating a patient?

What does the GMC say?

Patients must be treated fairly and without discrimination. The GMC guidance on refusing treatment is clear: “You should end a professional relationship with a patient only when the breakdown of trust between you and the patient means you cannot provide good clinical care to the patient.” A “breakdown of trust” is not defined, but the threshold for this is evidently high. The GMC specifically advises that a professional relationship with a patient cannot be ended solely because they have made a complaint about you. You are also not allowed to let personal views affect professional relationships. You cannot unfairly discriminate based on a patient’s protected characteristic (race, gender, age, disability, sexual orientation etc.). The GMC’s examples of what might trigger a breakdown of trust include violent or threatening behaviour, theft from your premises, and sexual advances, i.e., nothing trivial. However, if a patient consistently acts unreasonably or inconsiderately, this can give rise to a breakdown of trust.

The common-sense approach

Patients should ideally be given advance warning that you are considering ending your relationship with them, but in some circumstances, this is not always possible or safe. The decision to end the relationship should always be communicated to the patient in writing, and the justification of the decision should be documented objectively in the patient’s records. At CFC we often see situations where patients have persistently unrealistic expectations of their elective surgery. In circumstances where the patient demands nothing less than perfection, or you are not satisfied that they truly grasp the risks of surgery, it may be appropriate to suggest that you are unable to meet their expectations and recommend that they seek a second opinion. It goes without saying that a patient cannot be refused treatment if they require urgent care that they cannot access elsewhere, and in all cases, you should be prepared to pass on the patient’s records without delay.

Final thoughts

The decision to refuse to continue treating a patient should not be an easy one, and you should be prepared to explain and justify why you can no longer provide good clinical care.
While it is possible that your relationship with a patient who has complained about you has broken down, the complaint itself should not be the reason you decline to treat them.
Sending a letter outlining the reasons why you are no longer willing to see them can irritate or even enrage a patient. Backlash in the form of a complaint to the GMC or a scathing comment online should not come as a surprise, so think very carefully before taking this step.
Written communication on this subject should be worded very carefully. Always seek advice from your insurer before any correspondence is sent to the patient