Casebook Vol. 17 no. 3 - September 2009
Head of Medical Services (London), Dr Alison Metcalfe, introduces this issue’s round-up of case reports, which feature a number of different aspects of communication
Your communication with, or about, a patient will dictate the overall success of the clinical encounter for both you and the patient. It will determine whether the necessary rapport with a patient is established; whether there is proper continuity of care; whether the correct diagnosis is made; whether a problem, if it arises, can be successfully resolved. Communication can take a number of forms, even within the labels of written and spoken communication. This issue’s set of cases looks at examples of both the good and the bad and the potential outcomes that follow.
The case on page 16 demonstrates how important clinical examination is when faced with a patient who finds it difficult to communicate verbally. This may be due to a physical impairment, language problems or simply when a patient is faced with discussing a condition which may be embarrassing to them. It is important to equip yourself for dealing with such tricky situations, which may involve adapting how you communicate to help you overcome those issues.
Two cases in this issue highlight the limitations of verbal communication when you are not face-to-face with a patient – specifically during telephone consultations. Not only do such consultations preclude a physical examination, but they deprive you of the visual clues which are so vital in making an accurate diagnosis. It is important to be aware of these limitations and to exercise your judgment as to what you are able to accurately assess over the phone and whether you have sufficient information to make a reasonable clinical decision. It is also important to ensure that you make provision for appropriate safety-netting when faced with such situations; for instance, what action a patient should take in the face of worsening symptoms.
Another theme in this series of case reports is to be aware of the potentially serious alternative possible diagnoses when confronted with common presentations, such as earache, headaches and back pain. Being open to the possibilities and asking the right questions in such situations is important in avoiding unfortunate outcomes.
As good doctor–patient communication is a vital tool in diagnosis, it is also essential in communicating risk to patients undergoing procedures and ensuring that you have the appropriate consent. Being able to prove that you have made sure that a patient is aware of the risks involved with treatment is extremely important in defending any complaint, highlighting the importance of written communication, particularly your clinical records.
Casebook publishes medicolegal reports as an educational aid to MPS members and to act as a risk-management tool. The reports are based on issues arising in MPS cases from around the world. Facts have been altered to preserve confidentiality.
What’s it worth?
Since precise settlement figures can be affected by issues that are not directly relevant to the learning points of the case (such as the claimant’s job or the number of children they have) this figure can sometimes be misleading. For case reports in Casebook, we simply give a broad indication of the settlement figure, based on the following scale:
- High £1,000,000+
- Substantial £100,000+
- Moderate £10,000+
- Low £1,000+
- Negligible <£1,000.