GP Stories - Drug Seeking Patient

The healthcare system in the UK is under immense strain. Hospitals are full, emergency departments are facing 12 hour waits and GP practices are closing. The ones remaining are facing huge workload pressures, of patient's demanding appointments from a dwindling numbers of doctors. A browse of GP facebook groups more recently have been discussions on how to manage this workload, from allowing unlimited emergency slots, to triaging carefully once all the appointments of the day are used up so only certain demographics are allowed an urgent slot (children, end of life, etc.), to just closing the list totally and directing all calls to 111. Which one to choose is very individual to the practice, a balance on providing what you can to your patient demographic to protecting your doctors from burnout. 

This can leave patients who feel they need urgent needs resort to violence to get what they want. There have been increasing reports of violence against GP surgeries but I had not thought it would happen to our surgery. A patient who had a history of drug-seeking behaviour barged into our surgery. He started shouting that he needed his opiates and was demanding a prescription from Dr X. He was quite a large-set man and he scared a lot of patients in the waiting room with his behaviour. The reception staff wasn't sure what to do, understandably they were worried. The practice manager called the police but there was no telling when they would arrive. Thankfully a RAF trained GP was around working that day. After the patient started knocking on doors and opening the unlocked ones, he stumbled into that doctor's room. The military-trained GP (Dr RAF) stood up and firmly told him to stop his behaviour, and ordered him to sit down and wait in the waiting room. When he didn't do initially as he was told, Dr RAF showed him the 'palm', a technique he told us later to discipline his kids - basically raising your dominant hand and pointing to the inside edge of that hand. It seemed to work as it calmed the patient down enough to sit down in the waiting room. Dr RAF waited with the patient for 10 minutes until the police came, occasionally showing him the 'palm'. When the police came, they gave the patient the option to just leave without further incident otherwise he would be arrested. He instead chose to be arrested so they took him away. He was later delisted from the practice, which now is the 4th on his record.

Aggression against healthcare workers happens on a daily basis but with the rising tide of patient demand, workforce shortages and patient expectations then we can expect this incidences to occur more frequently. A recent attack on a GP surgery made the news when they trashed the waiting room. Maybe we should be adding a new role to the primary care MDT - the bouncer. 

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