Official Journal Of The Trinidad & Tobago Medical - the Trinidad and ...

Caribbean Medical Journal
Medicolegal Matters
The human touch
Gareth Gillespie, Editor, Medical Protection Society
Developing good interpersonal and communication skills
improves your clinical effectiveness as a doctor and reduces
your medicolegal risk, leaving you with a satisfied patient and
a considerably less stressful consultation. This is easier said
than done. It is when you are busy, stressed and doing your best
to cope with the multiple demands of current clinical practice
that you are most likely to find effective communication a
challenge.
And you will be unsurprised to hear that various studies have
shown that the quality of medical care is not the only thing that
determines whether a patient will make a complaint or seek
compensation.
Great expectations
Patients will frequently judge the quality of clinical competence
by their experience of their personal interactions with a doctor.
While patients want doctors to have good clinical and technical
skills, they rate interpersonal skills as more important.
This is likely to be due to there being understandable difficulties
for patients in assessing the technical competency of a doctor.
They will, therefore, frequently judge the quality of clinical
competence by their experiences of personal interactions.
Failings in interpersonal skills, which may eventually convince
a patient to sue, can be separated into two distinct categories:
predisposing factors and precipitating factors.
The former includes rudeness, inattentiveness and apathy, while
the latter can be borne out by adverse outcomes, mistakes and
failure to provide adequate care. Precipitating factors are unlikely
to lead to litigation in the absence of predisposing factors,
however.
Patients will be dissatisfied if their expectations have not been
met. Of course, many patients’ expectations are unrealistic –
that you have unlimited time and availability, will solve all the
issues at once and all treatments will be 100% effective and risk
free.
Body talk
The words we use are of less importance than the tone of voice,
or our body language. Letting patients tell their full story also
allows you to gauge their emotional distress; and, as patients
do not present problems in order of clinical importance, the
longer you delay interrupting, the more likely you are to discover
the full spread of concerns the patient wants to discuss.
Eye contact is critical in demonstrating interest and understanding,
particularly at the beginning and end of the consultation. Turning
away from the computer, offering full attention, and then
summarising what you have heard to check your understanding,
helps the patient feel understood and appreciated.
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A margin for error
Despite the best of intentions, there will be occasions when
patients or their relatives will be dissatisfied with the care you
have provided, or with the outcome they have experienced.
This may be due to human error, systems failure or unmet
expectations.
Complaints feel personal, hurtful and sometimes unfair. Your
best course of action initially is to discuss the situation with an
experienced colleague or your medical protection organisation.
The senior doctor responsible for the care of the patient should
be the person who advises the patient on what has occurred.
Above all, try to retain your professionalism, making sure that
you:
• Acknowledge what has occurred
• Find out the facts; discuss them as they become known to
you
• Provide an explanation
• Apologise
• Identify what can be done to prevent similar issues arising
• Adopt those lessons into your future practice.
There should also be a decision made on whether an incident
report should be filed and if there should be a sentinel event
review.
A summary of communication behaviours that reduce
medicolegal risk is set out below:
• Being available (returning phone calls, making and keeping
appointments), especially if something has gone wrong.
• Giving the impression that you have sufficient time for the
patient (which can be done without taking up much extra
time, and is achieved by not giving out “rushed” signals).
• Soliciting and understanding the patient’s viewpoint.
• Demonstrating empathy.
• Demonstrating “acceptance”.
• Explaining the process of the consultation.
• Giving explanations that are pitched at the patient’s level.
One step beyond
Doctors exist in a world of patient interaction with heads full
of clinical information, and it may seem that all you need to
bring to bear are your expertise, knowledge and technical
competence. Yet all of these hard-won skills and knowledge,
vital as they are, are not sufficient in themselves to make a good
doctor and avoid claims.
The vital ingredient is good communication and this, like all
skills, has to be acquired through hard work, experience and
application. Taking the time to talk and listen to patients, while
juggling the demands of work, is not time wasted and proves,
ultimately, to be highly rewarding.