The COVID effect on patient interactions

Does this sound familiar?

These are examples of comments heard in medical practices across Australia throughout the COVID-19 pandemic.

When should I end the doctor–patient relationship?

Thresholds for ending the doctor–patient relationship differ significantly across medical practices, but Ahpra and other health complaint bodies recognise that part of good medical practice is acknowledging when the doctor– patient relationship has broken down.

A good therapeutic relationship is one built on trust, communication, and mutual respect – and this often extends beyond the doctor and the patient. It’s not a good therapeutic relationship if the patient is polite to the doctor, but constantly rude to practice staff. And similarly, the doctor may have an excellent relationship with the patient but be subjected to constant abuse from a carer or family member(s). It’s not good for the doctor or the patient if the relationship has become dysfunctional.

Keep your cool

It’s often tempting to respond in kind when faced with a rude or abusive patient. Unfortunately, there’s nowhere to report rude patients, but plenty of places for patients to report doctors and practice staff. Keep your cool. This doesn’t mean you should do nothing, but it takes two people to argue. Sometimes the best way to take the heat out of the conflict is to simply remove yourself from the situation as soon as possible.

If someone becomes abusive on the phone, you can calmly advise the caller that you will be terminating the call and invite them to put their concerns in writing. If the patient becomes abusive in person, you can ask the patient to leave the practice and contact the local police if they refuse to do so.

Fear can be a powerful emotion

COVID-19 has changed our world, and a fear of the unknown can provoke enormous stress in the most unlikely people. There have been so many changes over the past two years that everyone in the community is feeling the stress, as evidenced by the increase in demand for crisis and mental health support services during the pandemic.

Practices have struggled to keep up with a multitude of rule changes, so it makes sense that patients will often be a step behind. A calm and reassuring approach is often best when faced with a patient who may be struggling to understand public health orders – but it’s also important to know when to back off. For every patient who genuinely wants to understand why they’re required to wear a mask in the practice waiting room, there may be another who is filming the encounter so they can accuse you of breaching their human rights and post it on TikTok.

In our experience, if a patient has a fixed view on mandates, masks or vaccination, there is little point in entering into a dispute with them. You may not agree with the patient’s point of view, but they are entitled to an opinion provided they do so in a respectful way. While you can provide your clinical advice and document the discussion in the notes, it’s pointless to get into a one-on-one argument with someone proffering an 87-page dissertation on why COVID-19 is a global conspiracy.

Make sure your policies are clear

Ahpra has issued guidance on facilitating care during the pandemic, and this has led to many practices putting in place interim policies to ensure they can continue to treat patients while keeping their doctors and practice staff safe.

For example, if you’re introducing an initial telehealth consult for patients who have respiratory symptoms, make sure your policies are clear and easy to locate. Some practices don’t advise patients about additional requirements until the appointment has been booked. This can lead to anger and frustration for the patient who may take it out on frontline practice staff.

If you have policies in place during COVID-19, ensure the policies are clearly explained anywhere patients may go for information – including your booking page, practice website, social media, or a sign on the front door. There’s no guarantee that a current or prospective patient will agree with your policy, but it will make everyone’s life easier if the policy is transparent. As long as your policies are not discriminatory and are written in accordance with the Ahpra guidelines, you can usually defend a complaint made as a result of your COVID-19 policy.

Where to get help

Sadly, we have seen some appalling behaviour towards the medical profession over the last two years. Doctors and their staff are doing their best to provide quality care under very difficult circumstances, and receiving unwarranted abuse can be a little soul-destroying for even the most robust health professionals.

MDA National has a dedicated COVID-19 webpage with some really useful FAQs and links. But for those tricky ethical dilemmas or for some reassurance and guidance, you can always contact our helpful Medico-legal Advisory Services team for prompt and personalised advice and support.

Case study: The COVID effect

Jennifer had been a patient of the practice for almost two decades, and she had always been polite and respectful to the doctors and practice staff. This was why Dr Jones was so shocked at the change in Jennifer’s behaviour at the start of the COVID-19 pandemic in 2020.

Jennifer complained loudly when she was advised that all patients attending the practice would be required to wear a mask. She said she had a history of anxiety which made it difficult to wear a mask, and she demanded Dr Jones provide her with a medical exemption. He checked her history and advised he couldn’t give her a mask exemption when his clinical records didn’t support a diagnosis of anxiety.

Jennifer asked for a transfer of her records to another local practice in the area, “because they said they would give me a mask exemption.”

The practice didn’t hear from Jennifer again until she booked an online telehealth appointment in late 2021. The practice contacted Jennifer and advised her that Dr Jones couldn’t do a telehealth appointment – because it had been more than 12 months since her last face-to-face appointment, and she didn’t meet the requirements for an “established relationship”. She abused the receptionist and slammed the phone down in her ear.

Jennifer booked a face-to-face appointment two weeks later. Dr Jones greeted her politely and asked what he could do to help her.

“I need a COVID vaccination exemption,” she said aggressively.

Dr Jones said he would consider an exemption if she met the requirements under the ATAGI guidelines.

“I am a teacher, and if I don’t get a COVID exemption I won’t be able to keep working,” she said.

Dr Jones sympathised with her situation but asked her on what medical basis she was seeking an exemption.

“What do you mean? COVID vaccinations are experimental, and I’m not a lab rat. My Facebook group said my doctor will give me an exemption on the basis that the vaccine mandate is affecting my mental health.”

Dr Jones explained the ATAGI guidelines and said that stress from a COVID-19 mandate did not trigger an exemption.

“THEN MAKE SOMETHING UP! You’re just like all the other doctors in bed with big pharma. When my children starve it will be your fault because you won’t bend the stupid rules and give me an exemption!”

Jennifer stormed out of the practice, refused to pay for the consultation, and swept everything off the reception desk on her way out.

Dr Jones and the practice staff were really shaken after Jennifer’s departure. A medico-legal adviser assisted Dr Jones with a letter ending the therapeutic relationship, and Jennifer was advised that no further appointments would be booked for her at the practice.

Subscribe to MDA National’s biannual Member publication, Defence Update, for the latest medico-legal updates, articles and case studies.

Subscribe now