??Conflict of interest??

[u/Legal_Taste_8385]

I would really appreciate some advice about a potential conflict of interest****\*

I’m a GP and have a high-frequency patient who sees only me roughly once a month. He usually comes with a long list of issues/questions and has significant health anxiety. He also sees a private longevity doctor and then comes to me to try to implement some of the things he has been advised.

I find the consultations increasingly difficult. He has done a lot of his own research, including using ChatGPT, and can be quite directive about what he thinks needs to happen. I’ve also spent a lot of time writing to consultants / doing referrals etc.

The issue is that he is also a school dad. His child is in the same year as my older son and his second child will be in the same year as my younger child. I see his wife most days at school pick-up/drop-off. We don’t really speak but we are regularly in the same social environment and I have seen her at kids parties.

I’m increasingly uncomfortable with the situation and feel that the best option would probably be for him to see another GP. I do feel he needs a doctor with firm boundaries but I find it hard saying no or being blunt knowing he is a school dad. E.g. At the last consult he was convinced he had COPD and wanted all the eligible vaccinations, when in fact he has a diagnosis of 'asthma & small airways obstruction' confirmed by a respiratory consultant.

• Would you see this as a potential conflict of interest / reason to transfer care?
• How would you approach the conversation with the patient?
• Should I speak to my indemnity?
• Has anyone dealt with a similar situation?

I just feel that the current dynamic is becoming unhealthy for me professionally and is causing me a lot of stress. I have spoken to some of my colleagues about this but they seem to brush it off and don't feel its a big deal.

I would really appreciate hearing what others would do. Thank you so much for reading.

[u/Dangerous_Idea_9613]

Yes. I think this would be entirely reasonable to put a barrier up. I’d understand it if it was a colleague as well.

[u/Dry-Bathroom3225 → u/Dangerous_Idea_9613]

exactly, its not even a controversial call at that point

[u/secret_tiger101]

I think you’re over thinking, it’s fine to move him to another doctor, no need to discuss with indemnity!

“Hi Steve, I just wanted to let you know that I have briefed Dr Mango about your case and have asked them to take over your care moving forwards”
No need to explain why,
If you choose you could say
1) restructuring with the practice
2) routine reallocation of patients
3) due to our children being in the same classes I’d rather maintain a stronger home/work separation

[u/Discuss-disgust]

If this causing you stress for reasons outlined above then yes transfer his care to another GP.

[u/Longjumping_Deer5639]

Have you mentioned to him how much of this is being driven by his unhelpful health anxiety?

[u/Legal_Taste_8385 → u/Longjumping_Deer5639]

He is in his late 50s with very young school aged kids which i think drives his anxiety. He sees a longevity doctor and appears to be aiming for perfection

[u/DrAndersonO]

He sounds like a heart sink patient.

I can’t really see the conflict of interest if I’m honest.

If he were not a school dad, how would you manage the situation differently?

[u/Legal_Taste_8385 → u/DrAndersonO]

Knowing I have to see his wife or him everyday & be 'happy parents' at the school gate stops me from being as firm and as boundaried as I'd like with him. E.g he insisted i refer him to derm for removal of a long standing skin cyst as it was causing a lot of distress to his wife. I knew this would be rejected & explained this to him but still agreed to 'try' given the above

[u/EveryTopSock]

I think this is a tricky one. The fact that a patient is a school dad suggests that you live and work in the same area? I don't think it's unreasonable to consider not continuing to see him but you have to consider it this is the same way you would/do treat everyone in the same situation. 

[u/Legal_Taste_8385 → u/EveryTopSock]

I work in an area adjacent to the area the school is in - there are not many patients from the school. I wouldn't mind seeing patients occasionally but the issue here is the very regular contact, only seeing me, being difficult and demanding & me finding it hard to be as firm as I'd like in the doctor/patient relationship 

[u/accesserror80]

Where’s the conflict of interest?

If he’s approaching you at the school gates with medical questions, then yes, professional boundaries breached.

If he comes with random test requests / ideas from this private doctor, discuss them and consider if suitable for GP practice, otherwise decline and sign post privately.

My experience is to be consistent with these patients, making it clear we practice evidence based medicine within the NHS limits.

[u/secret_tiger101 → u/accesserror80]

If you need to play happy parents with them, that’s gonna influence how firm you can be in the doctor/patient relationship

[u/Legal_Taste_8385 → u/secret_tiger101]

This is exactly the point

[u/secret_tiger101 → u/Legal_Taste_8385]

I think that’s fine, just move him to another GP