Casebook Vol. 15 no. 2 - May 2007

Head of Medical Services (London) Dr Mark Dudley introduces this issue’s selection of case reports

Effective handling of information is a fundamental requirement for effective clinical care. Many of this edition’s cases illustrate the difficulties that can flow from a failure to acquire or communicate clinical information. Doctors are expected not only to be readily accessible when on duty, but also to try to place themselves, in every case, in a suitable position to assess adequately a patient’s condition. This of course means taking a careful history, and performing a physical examination where appropriate. There are perfectly legitimate occasions when you need to use a telephone, or some other remote device, as a medium in patient management. In such situations it is vital to clarify as fully as possible the patient's current medical condition and relevant past history, and to ensure that the assessment of the patient's status is adequate in all the circumstances.

You should provide patients with such information about their condition as they request or require, in a way that is not only factually correct but genuinely comprehensible. These discussions and explanations should be documented within clear accurate records. As well as communicating with patients, you must share appropriate information effectively with your colleagues. It goes without saying that sharing such information with other healthcare professionals is a vital element of safe patient management. In one MPS study of UK general practice claims, up to 5% were attributable wholly or largely to communication or administrative failures.

With an ever-increasing emphasis on team approaches to healthcare delivery, communication may need to involve many more people than was previously the case, and there are now correspondingly many more opportunities for snarl-ups. Communications between primary care services, secondary carers, social and voluntary services may need to be modelled not so much on a linear chain as on an open network, within which any one node may need to communicate with any other.

There should be mechanisms in place to ensure that all members of such a network are appropriately informed of the patient’s current status, and of any relevant recent developments. Sharing such information must naturally be balanced against confidentiality considerations.

Good communication protocols have never been more important.