The Doctor/Patient Relationship in Private Practice

Do you know how to get it right from the start and what to do if it goes wrong?

Your doctor/patient relationships are sacrosanct. They require mutual trust and respect, communication, and empathy. In the majority of cases you will establish and successfully complete treatment relationships with your patients but, like all relationships, some should not have started in the first place, others start well but face difficulties, and occasionally the relationship entirely breaks down and has to be terminated. 

Incision knows that as a private surgeon providing non-urgent care, you need to know how to select the right patients for your practice from the beginning – and how to avoid taking on patients that you can never satisfy.  If challenges unexpectedly emerge later, you also need to know how to manage the patient relationship.  If matters reach the stage where termination of that relationship is permissible or even mandatory to comply with your professional conduct obligations, you need to know how to terminate that relationship with the minimum possible consequences for you and your patients.

Difficulties in the patient relationship can sometimes lead to compensation claims, GMC referrals or even police investigations.  Therefore you also need to be able to identify when you need medico-legal guidance on a particular patient, and also when to notify your insurers to protect your insurance position. 

Incision members have access to detailed written guidance materials (a toolkit) on these important topics, and this article contains extracts from that guidance.  Incision members also have access to a 24/7 medico-legal/notifications helpline so that their members always have access to guidance on individual cases.

The art of patient selection

To help protect yourself and be able to offer the best service to your private patients, you need to evaluate:

  • What is this patient looking for?
  • Am I the right surgeon to provide what they need?
  • Would it be in the patient’s interests to politely decline and refer elsewhere?

The question of how you effectively (yet efficiently) carry out this evaluation will depend on the features of your particular practice.  A robust process will likely include good pre-consultation paperwork (patient questionnaires and information leaflets), asking key questions at each initial consultation, and including certain information as standard in your follow up clinic letters.

These considerations have an overlap with obtaining Montgomery compliant informed consent.  The factors that help you evaluate whether you will be able to satisfy this particular patient’s expectations are often similar to the factors that help you understand what risks are ‘material’ to them.  The factors will depend on your medical specialism and practice, but to take just one example, a patient who wants to be fully recovered by the time of their wedding could have higher expectations of the surgical outcome and more likely to complain about non-negligent complications. If you always check in advance whether the patient has any special events coming up (or other time pressures) then you can make an informed decision about whether you want to take on a patient in the first place, and if so make expressly clear that they are accepting a risk of not being fully recovered in time for the wedding.

The art of patient selection is to develop and refine ways to identify the patients who are most likely to complain even if the treatment has gone objectively well.  Given your professional conduct obligations, it is considerably easier to politely decline to treat a patient and refer them elsewhere, compared with the difficulties of terminating a patient relationship once you have commenced treatment.

How to conclude the doctor/patient relationship after treatment has started

If you are considering discharging them from your care before their treatment is concluded, you will need to establish that termination of the professional relationship is justified.  This will need to be evaluated on a case by case basis, and ideally with medico-legal guidance on the GMC’s rules and guidance in these situations.

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Incision Indemnity

Incision Indemnity