The scene
A patient visited her GP, extremely anxious about a forthcoming family court appearance that she was unwilling to attend. She asked the doctor to write a letter to the court excusing her from appearing on the basis of her anxiety.
The doctor agreed to do so, but due to the pressures of other work and unavailability, the letter was produced by the practice support staff and sent out 'PP' on behalf of the GP, without him having seen it. The letter included an account of the patient's medical conditions and reflected the wording in the medical notes, which included a comment that the patient had been coping with a physically and emotionally abusive partner.
Some weeks later, the patient's partner complained to the practice, having been provided with a copy of the letter during the course of the proceedings. He objected to the description used by the GP and asked for whatever evidence the doctor might have to substantiate it.
MDU advice
The GP spoke to an MDU adviser about their dilemma. The adviser explained that letters sent to a court are likely to be disclosed to the parties in the proceedings.
Any doctor who arranges for a letter to be sent out with their name as author takes responsibility for the contents. In 'Good medical practice' (2024), the GMC expects doctors to take 'reasonable steps' to check information in documents they produce.
In this case, the GP's notes mentioned that the patient had been coping with an abusive partner. Whilst it is understood that in this context, medical notes will sometimes contain a note of something said by a patient which the GP cannot independently verify, the adviser explained that when preparing a report, the GP should take care to be clear that the report of domestic violence was based on what the patient had reported during a consultation, rather than independently verified by the GP.
The outcome
As a result of the conversation with the MDU adviser, the GP told the patient that her partner had objected to the description in the letter and that he would be writing to the partner to clarify the wording and apologise. The GP then wrote to the partner apologising that the letter was clumsily worded and confirming he made no judgement on the relationship. The partner did not respond.
Summary
This case led the practice to change its approach for producing and checking letters. The GP also shared learning with colleagues about writing letters for court, writing 'to whom it may concern' letters generally, and in wording of recording a patient's allegations in clinical notes and letters.
This page was correct at publication on 30/01/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.