By Alexander Humphries*

A patient who I’m going to call Ted moved into the area about nine months ago and for a while was really pleasant and polite. In recent months, however, his attitude deteriorated and he has been shouting at colleagues down the phone, reducing some of them to tears. Nasty stuff.

GP practices are able to de-register patients and hospitals can refuse treatment for abusive patients, but there is no mechanism for pharmacy teams to be able to deal with this problem.

Staff had complained frequently to me about how Ted was speaking to them and the increasingly unreasonable attitude that he was taking when it came to any problems. On Saturday morning he tried it on with me.

Ted had been receiving treatment for leg ulcers and was having his legs dressed by the district nursing team – until the nurses refused to see him because he was so abusive.

Frustrated

We had been regularly receiving prescriptions for him, which we normally delivered. But Ted had been getting frustrated because they had been “taking ages” to arrive from the surgery (he left another surgery and threatened to sue the GPs because of similar problems).

In this particular case I received a prescription that had been signed electronically by the GP at 7 o’clock in the evening, long after surgery finished. We received it via EPS on Saturday morning when we downloaded the first batch of scripts. “He’ll be wanting that delivered,” the dispenser told me. This was going to be awkward as we don’t have a delivery driver on a Saturday morning.

Sure enough, about an hour later, Ted rang the pharmacy to say he’d waited in all day Friday for his dressings to be delivered. I replied that the doctor had only signed the prescription at 7 o’clock the night before and we received it just that morning. Ted proceeded to rant on about how everyone kept letting him down. His tone was getting increasingly abrupt, as he was clearly prepared for a fight.

I explained to him that I didn’t have a delivery driver on a Saturday morning and even though I did happen to have a few of the dressings he needed in stock, I didn’t see how we were going to get them to him. One of your ladies has to walk past me to get home, was his response to that.

I told Ted there was no member of staff who lived on his side of town in work that day and we would not be able to get the dressings to him.

In the past, when confronted with this sort of situation, we have occasionally charged customers a small fee for an urgent delivery, mainly as a disincentive, but also to test whether they genuinely needed the item (you’d be amazed at how often the ‘threat’ of a £5 charge can persuade someone that their urgent moisturising cream isn’t so urgent after all). When told this, Ted said it wasn’t his fault and he didn’t see why he should pay.

At this point I could see we were getting nowhere and the conversation was just getting more and more counterproductive – so I decided to level with him.

“The reason that none of my colleagues want to go out of their way to help you is because of the way that you have spoken to them. On a couple of occasions you have left members of staff in tears. Their goodwill is wearing pretty thin.” Ted was taken aback by this. “I never meant to upset anyone,” he said. “I’m just in a lot of pain and I’m fed up with the way I’m being treated by the NHS.”

Out of order

I told Ted I would help him if he would help me. “Be polite and civil to my colleagues when you speak to them on the phone. Maybe then they will be happy to go out of their way to help you in future.” Ted agreed that his behaviour had been out of order and said that he would not get out of line again.

So, a few hours later, after we closed, I trundled up to see Ted with his dressings. We had a good chat on the doorstep, where again he apologised about his conduct and tried to explain his behaviour.

I am glad that I had the opportunity to experience this behaviour first hand and was able to resolve the situation in an amicable way. But what if I hadn’t been able to do so? What sanctions are there to deal with such a difficult patient, making unreasonable demands?

I know that I can refuse to deliver because this is a private service, but who wants to be on the front page of the local rag? The NHS apparently feels no responsibility for the wellbeing of pharmacy teams in the way that it does for GP practice staff. For me, this time, enough was enough.

* Pen name of a practising community pharmacist. Alexander Humphries’ views are not necessarily those of Pharmacy Magazine. How do you deal with awkward patients? Email pm@1530.com