The Medical Protection Society run a series of educational courses which are free to members (or a modest fee for non-members). I have been on three of them now & have found all of them particularly useful. The most recent one I attended was the Mastering Your Risk. This was a particularly useful one to go on especially after our last Human Error Problem Case meeting. I will try & summarise briefly some of my key take home messages.
It was a workshop based around managing risk before an adverse event occurs (there is also one for after when the adverse event has occurred). This is important as 50% of patients decide to sue before the adverse event actually happens which was news to me. This is for several reasons for example unrealistic expectations and poor communication skills.
The former was something we may be guilty of in aspects of our practice relating to rehabilitation. The concept of ‘over promising’ and ‘under delivering’ was discussed. It is a model which simply doesn’t work in business. Better to under promise & over deliver. However as clinicians we do not do this. I think of the number of referrals to physiotherapy or the amount of time our patients spend under rehabilitation when actually we should be realistic in what can be achieved. We are not helped by the system penalising patients who are unable to complete all physical tasks. We therefore, as patient advocates, do everything we can to try & restore full function. In a number of cases this is highly unlikely to be achieved and indeed increases our risk of litigation.
The latter aspect, communication, we generally do well as GPs. We use several consultation models usually involving exploring of ideas, concerns & expectations. The course introduced another model, C.L.E.A.R. ©. This is a 5 part consultation model the mnemonic standing for Connect, Listen, Empathise, Ask, Review (& check). It reminded me of Roger Neighbours model. However the important difference was the L.E.A. parts were similar to Pendleton & Tate’s model. It was a nice combination and whilst discussing & practising it, I thought it might be useful for a Registrar to use. Neighbour’s model is a useful summary but with an emphasis on safety with Pendleton & Tate’s being thorough yet lengthy. I have been given permission to discuss this in small groups so I can bring it along to the next PBSGL or Trainer’s Group.
The workshop was based on some very good research. The take home article which puts a very poignant perspective on why patients take legal action was by a lady called Susan Sheridan & Martin Hatlie (Sheridan, S. and M. Hatlie (2007). “We’re not your enemy: An appeal from a consumer to re-imagine tort reform.” Patient Saf Qual Healthc 4: 22-26.). I haven’t read it yet but will have done so by our next PBSGL. It is an American article but it does have relevant themes.
Finally the facilitator discussed ‘medical jousting’. This is the process of criticising other healthcare professionals involved in the care of the same patient. I think I have probably come across it most with junior hospital doctors criticizing GPs. I have had several consults where the patient was quoted the F2 ED doctor saying the GP should have given their son/daughter some antibiotics for their ear infection. It increases the risk of a complaint and subsequent legal action. I think the take home point is often we do not have all the information to hand so criticism may not be warranted. We also have to ask ourselves ‘would the other doctor concerned want to know what is being said about them by the patient or me?’. I certainly would & if there is a problem with a clinical decision I have made, I would like to know. Offer empathy, explain you may not have all the information to hand and certainly offer to contact or liaise with the other healthcare professionals involved. It can help defuse a situation & lead to a complaint being prevented.
I have some other interesting nuggets plus an excellent information booklet. I am happy to share themes and references at the next meeting or discuss anything via this blog in the interim.