Julie Baylis, Case Manager at Medical Protection, shares a recent case about a patient who was possibly impersonating another patient.
Mr K, a practice manager, telephoned the Medical Protection advice line to seek advice on dealing with a challenging situation. Mr K explained that the practice had a private patient, Mr L, who telephoned the practice regularly and had made numerous complaints in the past regarding practice staff on behalf of himself and his son Mr P, an adult, with his consent.
In order to investigate the most recent complaint submitted by Mr L on behalf of Mr P, Mr K and Dr G had listened to a number of recent telephone consultation recordings. On listening to these recordings, Dr G and Mr K became suspicious that Mr L had, in fact, been pretending to be Mr P over the telephone in order to obtain his son’s X-ray results. Although Mr L had provided the correct information for Mr P (name, address and date of birth), he had a distinctive way of speaking that they didn’t believe his son had. The results had been given out over the telephone. The same afternoon this incident was discussed at a practice meeting, with Dr G and the other GPs present. Some GPs present felt that Mr L should be considered for removal from the practice list due to this alleged impersonation of his son. However, Dr G disagreed and advised Mr K to seek advice from Medical Protection.
Expert advice
Mr K called Medical Protection and spoke to Dr D, an expert medicolegal consultant who had a background in general practice.
Dr D firstly advised Mr K to consider adopting a cautious approach, and that it would be important to consider very carefully whether they could face criticism for removing Mr L from the practice list on the basis of a suspicion. Dr D suggested that Mr K and Dr G must be confident that they had investigated the matter fully first, in order to be able to say with certainty that Mr L had been impersonating his son, prior to considering removal from the list.
Dr D suggested they may wish to consider inviting Mr L in to discuss the matter, to establish whether he had impersonated his son. If he admitted doing so, they should emphasise the importance of patient confidentiality and explore whether Mr P was aware that his father had obtained his results. Depending on the outcome, they would then be in a position to make a decision about how best to subsequently approach the issue with Mr P.
Dr D went on to advise that it would be the practice and Dr G’s decision on whether to remove Mr L from the practice list and highlighted the relevant paragraphs from the Medical Council guidance1:
“36.2 If you are unable to continue to care for a patient or group of patients either as an individual practitioner or as part of a team or group, you should tell the patient(s) and make arrangements for another doctor or service to take over their care. Until care has been taken over by another doctor or service, you are responsible for your patients. This means that you must provide emergency services and any care or treatment that your patients may need. When alternative medical care is in place, you should facilitate the transfer of the patients’ medical records without delay.
“36.5 If you feel unable to continue to provide effective care for a patient because the therapeutic relationship has broken down, you should get the patient’s consent to send all of his or her medical records to another doctor of your or the patient’s choice. You should document this in their medical records.”
Dr K highlighted that it was important that they consider whether they felt that there had been a breakdown of trust, between the GPs and Mr L, such that they felt they could no longer provide him with good clinical care. It would be prudent to explore any alternatives first, such as Mr D undertaking not to repeat his behaviour. Perhaps a warning would be appropriate, that any repeat of similar behaviour could lead to removal. It would be important to consider whether the therapeutic relationship could be restored, as well as considering if Mr L’s behaviour was out of character, perhaps influenced by illness, distress or anxiety for his son.
Dr D advised Mr L to be satisfied that the reason for wanting to end the relationship was fair and did not discriminate against the patient in any way. Dr D further explained that the practice may wish to consider whether they may face criticism for removing Mr L, given that he had an ongoing complaint with the practice. They may, in particular, have faced criticism if Mr L were to deny making the telephone call. It would also be important that Dr G was able to justify a decision to remove Mr L, should Mr L subsequently make a complaint to the Medical Council.
Dr D went on to explore with Mr K whether the practice had considered that a potential data breach may have occurred should Mr P’s confidentiality have been breached. Dr D directed Mr K to consider guidance offered by the Data Protection Commission (DPC)2 on General Data Protection Regulation (GDPR) requirements to report certain types of personal data breaches to the DPC within 72 hours of becoming aware. Under GDPR there is also an obligation to inform affected individuals of a data breach that is likely to result in a high risk to them.
There was a professional duty of candour to notify Mr P, if they believed that his results had been provided to Mr L in error. He should be offered an explanation and apology, as well as assurance about how the practice would prevent a repeat incident from occurring. Since Mr L was a practice patient, it was important to seek his consent first before discussing his actions with Mr P.
Mr K stated the practice would discuss the issue further that afternoon and decide on the appropriate course of action.
Learning points
• Follow Medical Council guidance if you are considering removing a patient from the practice list.
• It is important to consider if there are any alternatives to removal from the list.
• Removing a patient from the list should not be solely in response to patients lodging a complaint.
• Practices should ensure that they have the appropriate internal processes and security measures in place in order to minimise the risk of data protection breaches and that they are in compliance with GDPR and DPC guidelines.
For tailored advice regarding removing a patient from the practice list, please contact Medical Protection on 1800 936 077.
1Medical Council. Guide to Professional Conduct and Ethics for Registered Medical Professionals
2General Data Protection Regulation (GDPR). Breach notification