Friday, February 18, 2011

Professional Indemnity Tip # 2: Patient Consultation

By Heather Martin. Risks to your patients’ safety and wellbeing reside in many places – in your rooms, the operating theatre, on the wards and at home. The following risk management ‘quick-tips’ address medico-legal risk in relation to patient consultations.

Managing expectations is a critical component of the patient consultation. Ascertaining why the patient has come to you, their expectations of the consultation and any proposed treatment is conducive to:

  • Building rapport
  • Helping patients understand their medical problem
  • Clarifying options to enable choice and appropriate patient selection
  • Compliance with treatment

For the majority of your patients, you will already know or have a reasonable idea about their expectations. For other patients, you will need to ask what their expectations are.

A variety of interviewing techniques can be used to elicit this information. The final step is to correct or adjust unrealistic patient expectations if they don’t match what you or a treatment/procedure can provide.

Otherwise, when patient expectations are not met, or are unrealistic, a number of problems with the doctor-patient relationship may result, including:

  • Non-compliance with treatment
  • Patient dissatisfaction
  • Confusion or discordance regarding treatment aims and outcomes

Your interpersonal and communication skills and your ability to build rapport, are critical to establishing doctor-patient relationships that are grounded in trust and respect. Effective listening skills, allowing patients enough time to consider information and ask questions, acknowledging patient concerns, expressing empathy, and using appropriate body language are some of the components of good communication.

Although no one expects you to be able to “read patients’ minds”, there is an expectation, and a duty on the doctor to endeavour to find out whether the information provided to a patient has been understood or not. Patients are more likely to understand the information provided by you when communication techniques such as those described above are used.

Checking for understanding is critical in both setting realistic expectations of treatment and in any consent discussion. There are many ways to check for understanding – the methods chosen will be determined by the nature of your practice and your patients. Find out what the patient already knows about their condition or treatment options, Use questions such as:

  • “Does this make sense to you?”
  • “Who will you want to share this information with and what will you tell them?”
  • “Of all the things we have discussed today – which concerns you the most?”
  • “How will you know if the treatment/procedure has been successful?”

These types of questions are likely to elicit better feedback and provide you with a greater appreciation of a patient’s understanding.

  • Involve the patient’s significant others where appropriate – they may have further information that will enable you to better understand a patient’s motivations and concerns. They may also be able to rephrase information or contextualise it in a way that makes more sense to the patient
  • Patients who perceive they are being ‘rushed’ are less likely to ask questions or raise concerns, so ensure the ‘environment’ in which information is exchanged is conducive to effective listening and considered discussion, is free from distractions and free from pressure to make a decision on-the-spot.
  • Use basic medical terms and phrases.

Another important aspect of communicating with patients is ensuring the practice provides information about the practice itself: emergency contact details, consultation hours, how the fee schedule is structured. This information can usefully be included in a patient information sheet provided to new patients.

Heather Martin is the Risk Management Services Manager at MDA National. MDA National is a mutual Medical Defence Organisation (MDO), founded in Perth, WA in 1925 to protect the interests of its doctor Members. You can read more of Heather's articles under Professional Indemnity.

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