The Secret Diary of a Practice Manager Part 14

Should practices be made aware of past violent, abusive and threatening behaviour on a patient registering? Our Anonymous Practice Manager shares their experience.

We are aware that when we a remove patient under the zero tolerance rule they are then allocated a GP in the area and they have to be taken on. They will be aware at that time of the history.

Of course the patient can always move on and register elsewhere and the practice will not be aware of the past.

This I have always thought to be unfair and can put staff at risk.  This came home to me this week when we had an ugly incident.

Seeing the signs

Like most of you I have signs and notices that say we have zero tolerance against violence, aggression, threatening words and behaviour.

I like to think that my staff feel that with the threat of removing patients for the above helps them to feel safe and secure in their work and that we do carry out our pledge.

This week I have spent a lot of my time involved with a patient that I decided to remove, firstly by the 8 day rule and then by the immediate rule.

On Tuesday a patient called and wanted a repeat prescription, although since they registered, they had not seen either a doctor or nurse and failed to attend appointments.

The doctor quite rightly said he was not prepared to reissue medication without having seen the patient. I relayed the news to the patient who then went off on a verbal attack and made threats against the surgery and staff.

I advised her that we have a zero tolerance and that I was removing her under the 8 day rule.  The health authority were notified and agreed to the removal.

New day, same problem

The next morning the patient phoned again, asking for her medication. I explained that she would need to come to our open morning surgery to see a doctor.

Again a tirade of abuse and threats, however she turned up at the surgery and was booked in to see our locum doctor.

I decided to warn the doctor of the problems we had, and that if any problems, he could summon help with the emergency system that the practice has in place.

I went out to reception to be told that she had barged in to the window demanding to be seen and prepared to wait.  She then told the receptionist she could stick the prescription up her ****. and stormed out swearing and cursing.

Ok I thought only a week to go and thought she is unlikely to come back let’s just leave it.

But you’re making more work for me!

Wrong, next day another phone call passed to me and a repeat request for medication, I repeated our stance and was met with ramblings of swear words and threats, telling me she had 2 police officers recording my call, and she would do me.

Enough is enough so I instigate an immediate removal. Shortly after I received a phone call from the Health Authority (HA).

I was asked to reconsider my decision and keep her on for the remaining 6 days as they had already sent her that letter.

I say no way!  I was then met with an opinionated response from the person from the HA saying that they had spoken to the patient and she felt the patient had a point as she had complained to the HA.

I replied ZERO TOLERANCE is exactly  what it says, the HA person replied your making a big deal over this, it is not as though the patient pulled a knife, you must expect such behaviour?

Stunned as I was I bit my tongue trying to not escalate this situation and said I want this patient removed immediately.

This response was met with, oh I thought you would, I have had a run in with you before.

At that point I asked her name, and I responded in a polite but firm tone,

How would you like it if you were being threatened, what is there in the Zero tolerance that you do not understand?  You are now making this personal.

She may have remembered me? But I have not got a clue of any past clashes as the HA are normally very good.

She then said this will create more work for her. My response was, that is not my concern.  I want this doing.

I came off the phone stunned, however the call had been overheard and I was told why don’t you put in a complaint as this is unacceptable behaviour.

I called and spoke to her supervisor and have also lodged a formal written complaint.

Simmer Down...

It is a long time since I have been as shocked by something like this. The whole experience wound me up so much that I took time out for a walk to simmer down.

It will be interesting to receive a response to my complaint. Would I have done anything different?  No my staff are my responsibility and it is my duty to protect them but it does make you think!!

Surely we have a right to know of the past behaviour of patients as quite clearly this patient must have been causing trouble where she was before.


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