25
Covid vaccine queries When answering queries about vaccination it is appropriate to act in line with the relevant guidance in the NMC ’ s Code . 3 Respect patients ’ wishes to be involved in care decisions and support their right to accept or refuse interventions . Ensure that any patient who is receiving the vaccine has given properly informed consent and that you document this before administering the vaccine .
Patients who request more information about the risks and benefits of Covid vaccination can be provided with clear , accurate and up-to-date information . This should be based on the evidence about the potential benefits and risks of each option , including the option to take no action . The NMC Code states : ‘ Make sure that any information or advice given is evidence based , including information relating to using any health and care products or services .’
Answer reasonable questions that you feel confident to address , for example , about potential side-effects . You are not obliged to provide a detailed analysis of all current medical studies .
Warning patients Warnings to patients about behaviour , or removal from a practice list , can often result in a complaint ; it is important to be able to demonstrate that the decision taken was reasonable and proportionate . Any warning should be dealt with separately from a complaint response .
The standard GP contract usually requires a warning to have been issued before a patient is removed from
Being aware of techniques for diffusing difficult situations can help when dealing with challenging behaviour
References 1 MDU . Treatment waiting times and appointment availability leading to doctors facing abuse . September , 2021 . bit . ly / 3JOyDTZ 2 NICE . Violence and aggression : shortterm management in mental health , health and community settings , 2015 . nice . org . uk / ng10 3 Nursing & Midwifery Council . The Code . bit . ly / 3561uEn 4 MDU . Warning letters to patients : a practical guide . 2019 . bit . ly / 3LXBwDP a practice list . However , if there has been a threat of violence , or actual violence , and you have called the police , removal from the practice list without prior warning may be possible . Consider carefully how much confidential information might justifiably be released to the police and seek advice from your medical defence or professional organisation before making a final decision on removal .
More practical details about warning letters are available from the MDU . 4
Home visits Dealing with aggressive behaviour during a home visit can be particularly challenging given the unfamiliar setting and lack of backup support . If a situation cannot be defused it is acceptable to end a consultation and leave .
If a patient has previously been aggressive , conduct the visit with a colleague if staff numbers and workload permit . It may help to phone in advance to find out who will be present , outline what behaviour will be acceptable and get a feel for the patient ’ s mood .
Regular review Challenging consultations with patients or relatives are upsetting for all concerned . It is worth reviewing your practice policy on this issue , including security in the practice and on home visits , and having regular staff training to ensure you minimise the risk of patients becoming violent or aggressive .
Dr Ellie Mein is medico-legal adviser at the MDU