How to prevent litigation

Question 1

What is the most important factor causing complaints from patients and relatives against doctors?

Answer 1

poor communication

• according to the Medical Boards and Insurance Societies

Much of the art of general practice lies in the ability to communicate. patients and relatives against doctors.

Question 2

Rapport establishing techniques

Answer 2

• Greet the pt with a friendly, caring, interested manner
• Treat the pt with respect and courtesy
• Greet the pt with their preferred name (keep a reminder note in the history)
• Shake hands if appropriate
• Be well briefed about prior consultations
• Make the pt feel comfortable
• Be ‘unhurried’ and relaxed
• Focus firmly on the pt
• Use open-ended questions where possible
• Make appropriate reassuring gestures
• Follow-up contact including phone calls if concerned

Question 3

Active listening

Answer 3

is the single most important skill

Includes four essential elements:

• checking facts
• checking feelings
• encouragement
• reflection

Listen with understanding, in a relaxed attentive silence.

Use reflective questions, such as:

• You seem very sad today
• You seem upset about your spouse
• It seems you’re having trouble coping
• You seem to be telling me that . . .
• Your main concern seems to me to . . .

Question 4

Communicating strategies in the consultation

Answer 4

• Modify language
• Explain clearly, avoid jargon
• Provide clear treatment instructions
• Evaluate pt’s understanding
• Be non-judgmental
• Avoid stereotyping pts on appearance, culture, etc.
• Summarise and repeat
• Include the pt in decision making
• Avoid uncertainty
• Avoid unnecessary personal remarks or jokes
• Take care on sensitive issues
• Try to keep to time
• Avoid inappropriate reassurance
• Provide appropriate referral (if necessary) with explanation of contents of letter
• Ensure pt is satisfied
• Obtain informed consent

Question 5

The physical examination

Answer 5

Carefully explain the nature and purpose beforehand

Take particular care with explanations before PR, PV, breast and genital examination

Pre-empt and explain any possible discomfort and invite the patient to inform you about this

If undressing is necessary, explain to what extent it is required and why

Due attention to modesty such as privacy screens, sheets and gowns should be given

Allow the presence of a chaperone if requested

Do not lock the door of the consultation room

Allow cessation at any time due to any type of discomfort

Question 6

Summary

Answer 6

A fundamental prerequisite for effective communication is listening; this includes not only hearing the words but understanding the meaning in addition to being sensitive and compassionate

Undertake the strategies of paraphrasing and summarising during the consultation to emphasise that listening is occurring and to provide a basis for defining the problems

Associated with listening is the observation of the non-verbal language which may in many instances be the most significant part of the communication process

Emphasise the need to work together (50:50) for the best outcome

Good communication decreases the chance of dissatisfaction with professional services, even with failed therapy, and the likelihood of litigation

All good outcomes stem from the professional qualities of caring and responsibility