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Prevent complaints with good communication

Good communication saves time in the practice and reduces the risk of patient complaints, says Dr Emma Sedgwick from the MDU

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 hard to quantify what difference good communication makes to the doctor-

patient relationship. A survey published by the GMC shows patients have more confidence in doctors who communicate well1.

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 directly correlated to the doctor's ability to provide 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) 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 on how to be more open with people when mistakes are made2.

The NPSA also 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 the latest version of the booklet Good Medical Practice (2006). Paragraph 30 states: 'If a patient under your care has suffered harm or distress, you must act immediately to put matters right, if that is possible. You should offer an apology and

explain fully and promptly to the patient what has happened, and the likely short-term and long-term effects.'

We still sometimes hear it said, however, that to say sorry is to admit legal liability. But section 2 of the Compensation Act 2006 provides: 'An apology, offer of treatment or other redress shall not of itself amount to an admission of negligence or breach of statutory duty.' Giving a full explanation and apologising may help to resolve a complaint at an early stage and could help prevent a complaint or even a claim.

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, the vast majority 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 reassured 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.

Emma Sedgwick is a medicolegal adviser with the MDU

The case mentioned is fictitious, but based on cases from the MDU's files. Doctors with specific concerns are advised to contact their medical defence organisation for advice.

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