A challenging colleague

Whilst being a locum GP can have 
many advantages, there are possible drawbacks. Locums may not know the GP partners or the practice set up and can potentially find themselves working with a difficult colleague.

It may be a rose-tinted view to expect that every practice will welcome you with open arms, but it would be reasonable to hope that relationships with colleagues are professional and respectful and have patient safety at their core.

Occasionally, however, interpersonal difficulties may arise that start to impact on patient care, such as in the following case scenario.

“Don‘t listen to the locum...”

Dr A was halfway through a six month locum post at a busy three partner practice. She had seen Mrs H on five occasions with painful recurrent vaginal thrush. Each treatment only gave Mrs H a few days’ respite and she was getting increasingly concerned about the effect it was having on her mood and also relations with her husband. Diabetes had been excluded and after discussion with the local gynaecology consultant, Dr A prescribed her a six month maintenance course of 150 mg oral fluconazole once weekly.

The following week Mrs H came to see Dr A very upset. She had been to see Dr F, the senior partner, who had told her that the proposed treatment was unlicensed and that she should not take it. Dr A reassured Mrs H that, although unlicensed, there was evidence of the efficacy and safety of taking weekly fluconazole for recurrent thrush. Mrs H decided to start the treatment.

After another 3 weeks Mrs H came back to see Dr A. She explained that Dr F had told her that she was on the wrong treatment and that Dr A was only a temporary doctor at the practice. She felt she had lost faith in Dr A and had not taken the treatment.

She asked for a referral to gynaecology and Dr A agreed. Dr A spent time going through the rationale for proposing the treatment and the fact that it had been recommended by gynaecology. However, Mrs H told her that she didn’t know who to believe and wanted to wait to speak to the specialist.

Dr A was upset that Mrs H was unhappy with her treatment, as she felt she had acted in her best interests. She was also concerned about the behaviour of Dr F as this was not the first time he had adversely commented about her to patients. She sought advice from her medical defence organisation.

What action should Dr A take?

It is important that professional differences of opinion do not adversely affect patient care. The GMC expects doctors to communicate effectively, treat each other with fairness, work collaboratively and respect each other’s skills and contributions.

It appears, from what Mrs H has told Dr A, that Dr F has expressed doubt over the suitability of her treatment, with the result that she has not taken it. Dr F has not discussed his concerns with Dr A and she therefore does not know why he feels it would not be the right treatment for Mrs H.

  • Dr A should talk to Dr F to discuss his concerns about Mrs H’s proposed treatment. He may have information that Dr A is unaware of that he has based his advice on. It may also be that he is unaware of the current guidance on the treatment of recurrent thrush and he may welcome this information.
  • Discussions of this nature may be difficult, especially if Dr F is a challenging individual. It is important for Dr A not to appear critical and to emphasise that she has Mrs H’s best interests in mind.
  • Dr F may have an interpersonal issue with Dr A, since this is not the first time he has commented about her adversely to patients. If this is the case, Dr A may wish to discuss this with the other GP partner and seek his advice.
  • Dr A should not be tempted to do nothing - unresolved professional issues may prejudice patient care and it could be that other locum GPs have had similar experiences.
  • Dr A should keep a written record of all discussions that she has with Dr F and the GP partner.
  • Poor communication may be at the heart of many complaints and claims. In the above example, earlier communication between Dr A and Dr F could have resolved the matter before Mrs H lost faith in Dr A.

The GMC states that doctors must promote and encourage a culture that allows all staff to raise concerns openly and safely. Prompt action should be taken if patient safety is being compromised through another colleague’s actions.

Therefore locum GPs should be alert to the possibility of difficult relationships with colleagues and have a clear strategy in place of how to deal with situations such as this, should they arise.

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