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MDU: Give challenging patients behaviour contract

1 July 2015

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Doctors should consider an acceptable behaviour agreement to salvage a relationship with challenging patients, the Medical Defence Union (MDU) advised today.

General practice is likely to see the most problems with difficult patients as they are on the front line of patient care and has a long-term relationship with patients, the MDU suggested.

Dr Ellie Mein, medico-legal adviser at the MDU said: “Acceptable behaviour agreements can be useful in rescuing a deteriorating professional relationship before it becomes unsalvageable, rather than as a punitive measure. Such situations only arise rarely, as a result of persistently disruptive or unacceptable behaviour such as patients swearing at staff or making threats.

“Patients may be more receptive to signing an acceptable behaviour contract if it focuses not only on what is expected of them but also explains what they can expect of the service provider in return,” she said.

The MDU said that before asking the patient to sign a contract the doctor should consider if the patient’s behaviour is related to a long-term untreated medical condition, and that they have the capacity to understand what they’re agreeing to.

The agreement cannot prevent the provision of necessary care to the patient, and should follow the General Medical Council’s (GMC) guidance in ‘Good Medical Practice’ paragraph 71, requiring doctors to be open, honest and trustworthy when signing documents and taking reasonable steps to ensure what they are signing is correct.