High rates of co-morbidity with respiratory disease
To improve patient care, practice efficiency, and reduce the risk of complaints, it is important to ensure good communication.
Communicating well by introducing yourself to a patient, listening to what they have to say, checking they understand what you are saying and giving them the chance to ask questions may seem like common-sense but can sometimes be forgotten in the midst of an overbooked surgery.
The GMC says good communication involves listening to patients, respecting their views and beliefs, giving them information, apologising (if appropriate) and putting matters right if a patient suffers harm under your care.
It is difficult to quantify what difference good communication makes to the doctor/ patient relationship. A survey just published by the GMC shows patients have more confidence in doctors who communicate wel · 1.
The survey, of 996 patients, 203 GPs and 100 hospital doctors showed four out of five patients were confident in their doctor and that this confidence was directly correlated to the doctor's ability to provide adequate information.
By contrast, the GMC points out that 'for the 7 per cent of patients expressing a lack of confidence in their doctor, this mainly reflected their sense of the doctor's poor listening and explaining skills'.
In the MDU's experience, poor communication can also aggravate any problems that might arise. If the care of your patients does not go as expected, your communication skills will really be put to the test.
The National Patient Safety Agency (NPSA) recently launched an initiative designed to help doctors improve their communication skills when something goes wrong. The document, 'Being Open', advises NHS organisations to introduce a policy by June 2006 on how to be more open with people when mistakes are made2.
In an alert about the policy, the NPSA tells patients that if a mistake seriously harms them, they can expect one of the doctors or nurses involved to apologise, explain clearly what went wrong and what will be done to stop the problem happening again.
If something goes wrong the MDU advises members to give the patient a prompt and sympathetic explanation of what has happened and provide information about what will be done to try to prevent a recurrence.
We first publicly advised our members about the importance of being open and honest with patients about mistakes in our annual report for 1955/6. Saying sorry is enshrined in a doctor's professional code of conduct as set out in Good Medical Practice.
We still sometimes hear it said, however, that to say sorry is to admit legal liability. This is not the case. Indeed, giving a full explanation and apologising may help to resolve a complaint at an early stage and could avoid a complaint or even a claim altogether.
Most GPs appreciate that an honest and open approach is essential to maintain the trust that underpins the doctor/patient relationship. Indeed many are ahead of the game when it comes to resolving complaints by providing a thorough explanation and apology, if appropriate. Of the GP NHS complaints notified to the MDU, over 90 per cent appear to be resolved at a local level, many by providing this kind of response.
While it does no harm occasionally to stop and think whether there is anything we can do to improve the way we communicate, perhaps just as crucially, doctors need to be reasured that when they do admit a mistake, they are not unfairly blamed.
This is particularly significant as many adverse incidents are due to system failures, and seldom the fault of one person. For this reason it is welcome news that the NPSA's guidance stresses the need to ensure doctors are not unfairly blamed if mistakes happen.
HEADING off trouble
Tips for good communication during patient consultations
·Introduce yourself and check who the patient is
·Ask open questions and listen to the answers before responding; if necessary, repeat back a summary of what the patient has said to check you have understood
·Avoid medical jargon
·Before examining a patient, explain what you are going to do and why so that your actions are not misunderstood
·Be courteous but try to avoid over-familiarity some patients may resent being called by their first name, for example
·If a patient is unreasonable or rude, point this out, but try to stay calm and in control of your emotions
·If a patient has a genuine cause for complaint, eg a long wait to see you, apologise and explain why it occurred
·Record in the notes what has been said and what you found, or did not find, on examination
Good communication by all members of the practice team can enhance patient care, as this case illustrates
A woman complained that a GP had not visited her husband who suffered from emphysema despite her phoning the practice twice. The GP responded to the complaint by explaining that he had not realised a visit had been requested because the telephone note had been incorrectly recorded. He apologised for the misunderstanding and explained that the practice had reviewed its system for taking messages to ensure this mistake was not repeated. The complaint was successfully resolved.