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I have been in private practice for four years and during that time i have had a handful of clients i would call "a bit odd", currently i have one client who repeatedly makes flattering suggestive remarks and always tries to bring the conversation around to sexual matters, we could be talking about kitchen sinks and they can somehow turn it around. i would like to ask this client to go elsewhere for their treatment but just dont know how to do it. Any suggestions or similar experiences?

It your Practice Edward, So I would suggest that its very important that you fell confortiable the whole time. So I would suggest that you tell the patient that they make you feel uncomfortable and you will not be treating them anymore.

You can do this in 2 ways 1 after the next treatment tell them that this is there last treatment due to the fact that they make you feel uncomfortable, It very important that you stick to this line you don´t need to explain you detailed reasons to them and if the patient starts having a go at you gently ask them to leave. Do this yourself I would not get a receptionist to do this as them may get yelled at, others may differ on that.

the other way ring or send a letter explain in the same manor.

It may get a bit nasty as Patients don´t like to be told there not welcome I´ve done this once It very important for you to remain undercontrol and professional.

Ypu should not need to put up with any behaviour that makes you feel uncomfortable.

that my 5 cents

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Michael Weber

The most common thing about common sense is it´s not very common.

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I have had the same experience some years ago Edward.
I talked non stop about my husband how wonderful he was etc. you could try this just say you have a wonderful partner they will get the message eventually. This worked for me.
Hope this helps.

Jaynes.

You're in Devon and only have a handful of patients that are odd??? Keep the conversation away from kitchen sinks....

Seriously, confront him/her if you have the confidence and someone else in earshot. I used to have a patient who masturbated each time she came in to see me through a hole in her trouser pocket until one day I got sick of it and asked her to quit. It's all about psychology - your surgery is your territory - you take control and you determine the boundaries. Regrettably, the flattering suggestive remarks are few and far between these days.....

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"citing an indisposition due to special circumstances"

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Tell them that you have syphilis. Sigh, again

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Science is the antidote to the poison of enthusiasm and superstition

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Simon, surely that will fuel the fantasy?

Devon Pest and Edward1so can become partners down the GUM clinic.

GB

I had a lady wearing very long tights under her trousers once. I asked if (whilst I leave the room) she would take her tights off.

I came back into the room, and she had not put her trousers back on! I politely asked her to do so and told her never to remove her trousers/dress or T-shirt/blouse unless you are specifically asked to do so, and that any medical professional who asks you to do so, must have very good reason to do so!

I also documented this in the patient's notes! In reality, she was a severely anxious person, who (meant in the nicest possible way) was not all there mentally!

Or keep playing this song everytime the come in. and change a few words to I´ve got the Jack sing it with me know.

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Michael Weber

The most common thing about common sense is it´s not very common.

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But Disgrunted, the only way to remove very long tights is to take the trousers off first. She just forgot to put the trousers back on again, anxiety can do this - make you forgetful. Or perhaps you didn't give her long enough to complete the manouvre?

I don't think in this instant your patient was making sexual advances unless they were very subtle ones.

Must admit I am fascinated by what very long tights are...did they arrive in folds around the ankle.... a bit Norah Battyish.....

GB - off to stand outside for a while.

Edward

Seriously, dealing with miscreants does come with age and maturity. Could have something to do with becoming less attractive perhaps? Or more likely you are less tolerant of such behaviour.

In all instances I have always asked the patient that I find their conversation offensive and have asked them to stop. I make sure they are never the last patient before lunch or the last one of the day. Always make a note in their records of inappropriate behaviour - this could also be classed as subjective if you are asked to defend yourself of course. If you have a receptionist you could ask them to sit in on treatment sessions giving a valid reason why - you find their conversation distrurbing and require support whilst you treat. If patient objects on grounds of confidentiality then you have your reason not to treat.

Also if ultimately you need to ask a patient to stop attending, I would advise doing it in writing via recorded delivery, marked confidential. I would not do this in a face to face situation. It becomes your word against theirs.

Miscreants always seem to have a number of friends, family members who once kicked all seem to limp as well. Has anyone else noticed this?

Also if you're a member of a professional body, ask their advice on this situation.

I wish you luck as it is an uncomfortable position to be in.

By the way, these days I seem to attract only those who wish to alter my religious beliefs.

GB

thank you simon, thought i'd kept the STD thing under wraps, the chiropody clinic is only a cover for my other work!!!!!

Never really felt threatened by sexual advances and always managed to get out of potentially difficult situations without much discomfort - either mine or the patient's. ButI do find that I'm becoming less tolerant of the person who's convinced they have to save/convert/inculcate me to their particular belief. A number E11 inserted just distal to the heel pad and dragged slowly forward up to the interdigital cleft usually refocusses our relationship on more favourable terms.....

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"citing an indisposition due to special circumstances"

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Never forget having a locum Chiropodist once about 2/3 years ago - tall, dark, male. Worked on a patient with serious hyperkeratosis. An hour later, a firm but reasuring application of emollient was rubbed into the problematical foot lesions.

The patient still relates the experience to me. He claims there was something desperately wrong about a bloke giving another bloke a foot rub. We agree that no bloky foot rub takes place.

Works all ways doesn't it?

GB

Maybe it was the suggestion of wrapping the appendage in cling-wrap that gave him the willies. I remember a Fylde prop/forward taking fright at the news that he was going to feel a little prick between his toes one afternoon. Sometimes it's the way you say it....

So what do you do then.....wear your Friday attire?

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"citing an indisposition due to special circumstances"

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... doesn't bother me nowadays, if they look anguished with it I usually just drop my dacks tooo


yep one of my "Rules" also George


..always, the 'girls' usually 'jump' at the chance to sit in, great opportunity to catch some gossip


..you're stuffed!


.. a Black's file down the sulci gently lifting the nail edge with the obligatory "oh I'm sorry" gasp

That I am led to believe was a new experience. Just not sure the right appendage got wrapped. I did not witness.

Yes. The special outfit....

GB

Mark,


Are you sure she wasn't adjusting a catheter? And how long did you say it was before you got fed up with it?

edward1so,
we make jokes but this must be a very uncomfortable experience. You need to be very firm but polite and say "I'm sorry Mrs Bawdymouth, but I don't want to talk about that, it's not appropriate." Difficult I know, but you could rehearse what you are going to say before she comes in. You must put a stop to this and I would also obtain advice from your professional organisation. Keep a record of her inappropriate remarks and what your response was. If she persists in this unacceptable behaviour after she has been told to stop then she is actually harassing you.

Dido

Why assume it a female making these sexual suggestions it could be a male. Edward has not defined the sex of the person. This could be the 1 reason why he feels uncomfortable

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Michael Weber

The most common thing about common sense is it´s not very common.

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edward is a name i use as it is easy to remember (my dog), i am a female and the client is male. i am saying this as after reading many of the helpful comments i reflected on why i was uncomfortable. if it was Brad Pitt trying to lead me into a discussion of erotic French films (yesterdays topic - the final straw) would i be so offended. yes i would, your all right- it is unacceptable in any professional environment. i have taken on board all your helpful comments and had a bit of a laugh and been reassured i am not the only one. I also apologise if you feel mislead by my male user name :)))

Why? Did she not tip afterwards?

That is one funny story. The only pocket related story that could beat that would be if a male patient (or very special female) impersonated an Elephant.

Back to the serious topic.

Edward1so, its is very difficult, but the advice up till now has been correct.

You need to establish your authority, and reestablish the professional boundaries with that person.

I always take care of these kind of issues (call be a masochist).

I find the best way is to start with

'Hi patient X, can we have a chat? Listen, I am sure you do not want to cause offense, and are just trying to be friendly, but I feel uncomfortable with some of the comments you make. For example, when I was talking about the weather, and you managed to turn the conversation round to how you have sound proofed your attic, so no one would be able to hear anybody scream.'

'I don't want to fall out, and value you as a patient. So, if we can put this behind us, and start afresh that would be great.'

When approached directly, but with the preamble that you are not accusing them of intimidation, they normally say 'sure, point taken' or break down and cry using the death of a family member, or the fact that they didn't get a lollipop on sports day in 1983, as an excuse for their weird behaviour.

If you really feel intimidated, then maybe a letter is the other route.

If you do confront somebody, it is important to have backup, other colleagues around to support you. Documenting everything in notes is of course the correct way to do things.

We are in the fortunate position of always having at least two staff on site, and normally a male too (yes that is sexist). When we do get a problem patient, the conversation normally comes round to the thought that to be a single IPP treating in clinic or doing doms (even NHS Pods doing doms on their own), certainly has some potential risks.

Ah, the joys of working with the public...

Can you imagine if reflexology wasn't a bunch of hokum? ( :) ) It would mean we were touching an erogenous zone 15-20 times a day. Eww.

Catheter? She was only twenty eight. About six years.

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"citing an indisposition due to special circumstances"

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Mark,

Age is no barrier for a catheter.

You don't mention how many times she came in those 6 years. Once a month, every 8 weeks, 12 weekly....? What more frequent than that? Never!

GB

I have no idea. There are some things I think it better not to ask. She rarely missed her 10 week appointment though.....

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"citing an indisposition due to special circumstances"

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i think you have to explain to the patient exactly how uncomfortable you feel regarding his comments.
give him the benifit of doubt that he didnt realize that you felt ill at ease with his inappropiate talk.
if he is a seaze he wont be back once confronted.

be sure some one is there with you for support as well.

I feel that I must protest in the strongest possible terms as it seems that some people just aren't taking this seriously. Some of my patients have, on occasion, made incredibly rude remarks, it's so shocking.

Some examples are

'Can you have a look at my crack it's a bit sore today'.

'It's just a little prick but it's driving me nuts and I can't get it out, can you do it for me'?

'I've got a sore spot on the bottom'

'My balls really ache today'

'Been feeling a bit stiff in the morning but once I get a grip I can usually shake it off'

'How often do you think I should come'?

'Should I pull it off myself or wait for you to do it'?

'I've got a stiff swollen foot and it wont go down no matter how much I rub it with cream' (NB That's just exaggerating, I bet its not nearly 12 inches)

nudge nudge, say no more, know what you mean squire, eh! eh!

LoL Dave

PS. Hey Edward1so - I bet the Australian readers didn't even understand the problem in your situation.


PPS. No seriously tho, just do what us guys always do, just say you'll see him soon and then never ring. Avoid confrontation, it's all too ugly

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Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

Well Edward I am sorry your services are being abused like this.I advise you to send this patient a letter by recorded second class mail informing her that you have discharged her from your care and cancelling any future appointment she may have made.You should not let this linger as it could come back and bite you hard...

heres an update. The patient rang today asking for an emergency appointment for a new problem. i rang the Society of chiropodists to ask if there is a protocol for discharging patients in private practice, they advised me to ring the HPC. I rang the HPC who logged my call and explained that if the client complained they would investigate but that the are cautious about spurious complaints. sooooooo i wrote to the client explaining that i felt that my professional boundries had been breached and i was unable to effectively continue his treatment. My reason being i was uncomfortable discussing his private life. i sent it registered post today as per infallablejeff's suggestion. i just couldnt face another excuciating 1/2 hour. i am expecting some kind of reaction from this person, will let you all know what happens.

The client has replied to my letter! They are not at all happy and have stated that any boundries that had been breeched were due to my behavior (its all my fault). The letter was very unpleasant and has made me feel extremly uncomfortable and confirmed my beliefs about their conduct. if i were to be in this situation again I am not sure i would be as honest in my letter of discharge. Oh well, live and learn and i hope thats the end of it.

Don't be so sure. Your "client" will probably report the incident as a complaint to the HPC. If there is a suggestion of impropriety of a sexual nature on your part, you may find yourself the subject of an interim practice order which prevents you from practising until a hearing can be held to test the alegation in the complaint. If you are lucky, they may just mount an investigation - without informing you - to gather evidence then you will be informed at a later date if you have to attend a hearing to answer the compainant - i.e. your client. The Society should have been your first port of call, but sadly true to form, they seem to have been as incompetent as ever.

Next time...... confront the patient at the time of their inappropriate behaviour - ensuring you have an independent witness. If you haven't had a satifactory conclusion - call the police and log the incident with them. Get yourself along to some assertive training classes at your local community centre asap. If you can't do any of the foregoing, consider a career change.

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"citing an indisposition due to special circumstances"

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thanks Mark, i am considering a career change. The pub is looking for a cleaner and thats looking quite appealing at the moment. I am not afraid of the Hpc, and will continue to practice in an open, honest way. I have the backing of the society and the Hpc were sympathetic when i rang. I do not usually have a problem with innaproppriate behavior and can usually deal with humdrum innuendo or mild flirtation, this was different, i felt afraid to confront this person and, with hindsight, with good reason. Gut instincts are not often wrong. I hope this never happens to you.