Failures of communication

Underpinning good patient care is good communication, and this goes beyond establishing good relations with patients. In today’s team approach to delivering healthcare, communication has to extend to more people and there are therefore more opportunities for it to fail.

Keeping people informed in the interests of continuity of care must be balanced against the need to maintain confidentiality

The doctor–patient relationship has evolved over the years, moving from a paternal to a partnership model. In its most recent edition of Good Medical Practice, the GMC says that doctors should “work in partnership with patients” by listening and responding to their concerns and preferences, giving them “the information they want and need in a way they can understand”, respecting their right to be involved in decisions about their treatment and care, and supporting them in their own efforts to “improve and maintain their health”.

Communication between primary care, secondary care and social and voluntary services should be seen not as a chain, but as a communication net, within which any one member may need to communicate with any other (see Figure 1 on page 12 - The Communication net). Good management requires all members of the communication net to be conscious of who is doing what – an adequate standard of continuing medical care can be achieved only if all participants – both medical and non-medical – understand their roles.

Keeping people informed in the interests of continuity of care must be balanced against the need to maintain confidentiality, and both these issues should be borne in mind when sharing relevant information about patients. Unless the patient asks
you not to, it is entirely appropriate to share information about patients with people involved in their care. In its guidance, Good Medical Practice, the GMC tells doctors that “sharing information with other healthcare professionals is important for safe and effective patient care” and “when you refer a patient, you should provide all relevant information about the patient, including their medical history and current condition." ¹⁰

The GMC also says, in its guidance on confidentiality: “You should make sure that information is readily available to patients explaining that, unless they object, their personal information may be disclosed for the sake of their own care and for local clinical audit. Patients usually understand that information about them has to be shared within the healthcare team to provide their care. But it is not always clear to patients that others who support the provision of care might also need to have access to their personal information.”¹¹ When it comes to communication with other agencies, however, the GMC warns that “patients may not be aware of disclosures to others for purposes other than their care, such as service planning or medical research. You must inform patients about disclosures for purposes they would not reasonably expect, or check that they have already received information about such disclosures”.¹²